Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate

Abstract

AIMTo evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB).METHODSIn our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy’s lesions, and 1 had duodenal diverticular bleeding.RESULTSOf the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.CONCLUSIONModified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.

Endoscopic obturation with tissue adhesive for bleeding gastric stromal tumor: a case report

“…It is also considered to be an effective and inexpensive salvage alternative to surgery when there is no time for selective arterial embolization. 14 There was no time to choose selective transarterial embolization because in this case, the tumor was too large to be clipped. Thus, endoscopic obturation with tissue adhesive was used to treat the life-threatening active bleeding.…”

“…Endoscopic variceal obturation (EVO) with tissue adhesive has been well established in the endoscopic management of GI variceal bleeding, and it can also be used in the endoscopic treatment of duodenal, gastric or anastomotic ulcers, post-mucosectomy bleeding, Dieulafoy’s lesions, and duodenal diverticular bleeding. 14,15 Tissue adhesive, which is safe and without any side effects, can be used for endoscopic hemostasis with high surgical risk. It is also considered to be an effective and inexpensive salvage alternative to surgery when there is no time for selective arterial embolization.…”

Histoacryl glue injection without lipiodol dilution and post sclerotherapy bleeding; prevalence among patients with upper GIT bleed.

“…There are various endoscopic methods to stop bleeding such as thermal coagulation, sclerotherapy, laser excision and clip placement. 10,11 Gastric varices are present in 20% cases having portal hypertension and 35%-90% cases have recurrence of bleeding after spontaneous hemostasis. Cyanoacrylate glue injection is a treatment of choice in cases with acute upper GIT bleeding or for secondary prophylaxis.…”

Multifaceted Design and Emerging Applications of Tissue Adhesives

“…[ 282,283 ] Their stiff matrix and cytotoxicity can pose additional risks, thus they are only considered as the last resort. [ 284 ] The applications of fibrin glues have shown no significant enhancement of wound healing. [ 285 ]…”