Procedure-related complications in gastric variceal obturation with tissue glue

Guo, Yi; Miao, Hui-Biao; Wen, Zhiyuan; Xuan, Jie-Ying; Zhou, Haoxiong

doi:10.3748/wjg.v23.i43.7746

Cited by 24 publications

(16 citation statements)

References 31 publications

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“…It is worth mentioning that these hydrogels show suitable gelation time (Table S1) and can be administered in a more convenient and simplified condition that is suitable for the first aid use of severe gastric hemorrhage in emergency situations. Specifically, the AA/AA-NHS hydrogel precursor solution exhibits a suitable gelation time (< 9 min), indicating that the hydrogel polymer solution can pre-polymerize for 3 min and then remain injectable after transfer to a 23-gauge endoscopic injection needle that is widely used in clinical application [ 42 , 43 ]. Movie S1 shows that the hydrogel can be extruded through a 23-gauge needle without clogging after polymerization for approximately 3 min, and then the polymer solution will immediately gel after contacting the acidic solution.…”

Section: Resultsmentioning

confidence: 99%

Injectable Self-Healing Adhesive pH-Responsive Hydrogels Accelerate Gastric Hemostasis and Wound Healing

et al. 2021

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Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are well-established therapeutics for gastrointestinal neoplasias, but complications after EMR/ESD, including bleeding and perforation, result in additional treatment morbidity and even threaten the lives of patients. Thus, designing biomaterials to treat gastric bleeding and wound healing after endoscopic treatment is highly desired and remains a challenge. Herein, a series of injectable pH-responsive self-healing adhesive hydrogels based on acryloyl-6-aminocaproic acid (AA) and AA-g-N-hydroxysuccinimide (AA-NHS) were developed, and their great potential as endoscopic sprayable bioadhesive materials to efficiently stop hemorrhage and promote the wound healing process was further demonstrated in a swine gastric hemorrhage/wound model. The hydrogels showed a suitable gelation time, an autonomous and efficient self-healing capacity, hemostatic properties, and good biocompatibility. With the introduction of AA-NHS as a micro-cross-linker, the hydrogels exhibited enhanced adhesive strength. A swine gastric hemorrhage in vivo model demonstrated that the hydrogels showed good hemostatic performance by stopping acute arterial bleeding and preventing delayed bleeding. A gastric wound model indicated that the hydrogels showed excellent treatment effects with significantly enhanced wound healing with type I collagen deposition, α-SMA expression, and blood vessel formation. These injectable self-healing adhesive hydrogels exhibited great potential to treat gastric wounds after endoscopic treatment.

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Section: Resultsmentioning

confidence: 99%

Injectable Self-Healing Adhesive pH-Responsive Hydrogels Accelerate Gastric Hemostasis and Wound Healing

et al. 2021

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“…Complications and adverse events secondary to injection of tissue adhesives have been documented in a number of case reports and small case series. These are predominantly embolic in nature with reports including the development of pulmonary emboli, splenic infarction and cerebral stroke following glue administration, however localised and technical complications can also occur [ 25 , 26 , 27 ]. The technique when administering glue is critical to avoid irreparable damage to the endoscope or accidental adhesion of the injection needle to the varix.…”

Section: Discussionmentioning

confidence: 99%

Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience

Gillespie

McAvoy

Yung

et al. 2021

JCM

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Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre. This was a retrospective observational study. Patients with portal hypertension who received endoscopic injection of recombinant thrombin were identified and data collected on haemostasis and rebleeding rates, complications and mortality. Patients were grouped by indication for thrombin injection: gastric/oesophageal/ectopic varices and endoscopic band ligation (EBL)-induced ulceration. 155 patients (96M/59F, mean age 58.3 years) received endoscopic thrombin injection. Mean volume of thrombin injected at index endoscopy was 9.5 ml/2375IU. Initial haemostasis was achieved in 144 patients (92.9%). Rebleeding occurred in a total of 53 patients (36.8%) divided as follows: early rebleeding (<5 days from index endoscopy)—26 patients (18%); rebleeding within 30 days—42 patients (29.1%); delayed rebleeding (> 30 days)—11 patients (7.6%). There was statistically significant difference in rate of initial haemostasis between Child-Pugh A/B patients vs Child-Pugh C (p = 0.046). There was no significant difference in rebleeding rates between different indication groups (p = 0.78), by presence of cirrhosis or by Child-Pugh Score. All-cause mortality at 6 weeks was 18.7%; 1-year mortality 37.4% (median follow-up 48 months). There was no significant difference in mortality between groups (p = 0.37). No significant adverse events or complications were reported. Thrombin is effective and safe for gastric varices and other portal-hypertension-related bleeding including oesophageal varices, ulcers secondary to EBL and ectopic varices.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Ayub

Hussain

Ahmed

2020

TPMJ

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Objectives: To determine role of histoacryl injection in preventing upper acute upper gastrointestinal bleeding. Study Design: Prospective Study. Setting: Gastroenterology ward of DHQ Teaching Hospital Gujranwala. Period: One year from 1st September 2017 to 31st August 2018. Material & Methods: Patients presented to the study hospital having upper gastrointestinal bleeding of acute onset due to gastric varices bleeding were included in this study. All other cases having upper GIT bleeding due to other causes like peptic ulcer disease, Mallory weise syndrome, gastritis or esophageal varices were not included in this study. Both male and female patients were included irrespective of their age. Hemostasis in these cases was achieved by endoscopic sclerotherapy using histoacryl glue (N-butyl-2-cyanoacrylate) injection without lipoidal dilution. After first session of injection patients were called on follow up after 5 days and they were assessed for recurrent GIT bleeding and treatment failure. All data was documented on a predesigned performa. Frequencies and percentage were calculated and results were expressed in tabular form and graphs. Results: Total 80 cases were studied including 56% male and 44% female cases. Endoscopic sclerotherapy using histoacryl injection proved successful in 87.5% cases and recurrent bleeding occurred in 12.5% cases. Minimum age of patients was 25 years and maximum age 70 years with mean age of 45 years. Total 450 cases presented in study institution with Upper GIT bleeding during study period and causes among them were liver cirrhosis in 92% cases, peptic ulcer disease in 4% cases, Malloryweise Syndrome in 2.5% and gastritis in 1.5% cases. In our study group cause of gastric varices was liver cirrhosis due to viral hepatitis in 73% cases and alcoholic hepatitis in 27% cases. After single session of endoscopic histoacryl glue injection to 80 cases, no bleeding occurred after 5 days in 71(88.7%) cases, recurrent bleeding occurred within 5 days in 9(11.2%) cases. Two cases died due to massive recurrent bleeding and mortality rate was 2.5%. Conclusion: Endoscopic sclerotherapy using Histoacryl injection is very successful treatment for acute upper gastrointestinal bleeding with very low recurrence rate of bleeding and low mortality rate.

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Procedure-related complications in gastric variceal obturation with tissue glue

Cited by 24 publications

References 31 publications

Injectable Self-Healing Adhesive pH-Responsive Hydrogels Accelerate Gastric Hemostasis and Wound Healing

Injectable Self-Healing Adhesive pH-Responsive Hydrogels Accelerate Gastric Hemostasis and Wound Healing

Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience

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

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