Quality statement 8: N‑butyl‑2‑cyanoacrylate for gastric variceal bleeding

Quality statement

People with acute upper gastrointestinal bleeding from gastric varices are given an endoscopic injection of N‑butyl‑2‑cyanoacrylate.

Rationale

Endoscopic injection of N‑butyl‑2‑cyanoacrylate can obliterate gastric varices, whereas attempts at banding are likely to be unsuccessful for these varices.

Quality measures

Structure

Evidence of local arrangements to ensure that people with acute upper gastrointestinal bleeding from gastric varices are given an endoscopic injection of N‑butyl‑2‑cyanoacrylate.

Data source: Local data collection.

Process

Proportion of people with acute upper gastrointestinal bleeding from gastric varices who receive endoscopic injection of N‑butyl‑2‑cyanoacrylate.

Numerator – the number of people in the denominator who receive endoscopic injection of N‑butyl‑2‑cyanoacrylate.

Denominator – the number of people with acute upper gastrointestinal bleeding from gastric varices.

Data source: Local data collection. Contained in NICE audit support for Acute upper gastrointestinal bleeding: initial management (NICE clinical guideline 141).

Outcome

Rates of uncontrolled bleeding in people with acute upper gastrointestinal bleeding from gastric varices.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with acute upper gastrointestinal bleeding from gastric varices to be given an endoscopic injection of N‑butyl‑2‑cyanoacrylate.

Healthcare practitioners give an endoscopic injection of N‑butyl‑2‑cyanoacrylate to people with acute upper gastrointestinal bleeding from gastric varices.

Commissioners ensure that they commission services that give an endoscopic injection of N‑butyl‑2‑cyanoacrylate to people with upper gastrointestinal bleeding from gastric varices.

What the quality statement means for patients, service users and carers

People with acute upper gastrointestinal bleeding caused by enlarged veins in the stomach are given an injection of N‑butyl‑2‑cyanoacrylate, a substance that helps to stop the bleeding. This injection is given using an endoscope (a narrow, flexible tube with a camera at its tip).

Source guidance

  • Acute upper gastrointestinal bleeding: management (NICE clinical guideline 141), recommendation 1.5.5.