Successful treatment of a giant exposed blood vessel in a gastric ulcer by endoscopic sclerotherapy with N-butyl-2-cyanoacrylate

Kurokohchi, K.; Maeta, Takao; Ohgi, Tomohiro; Ono, Midori; Yoshitake, Akira; Yachida, Tatsuo; Yoshida, Motoki; Mori, Yoshiaki; Kohi, Fumikazu; Kuriyama, Shigeki

doi:10.1055/s-2007-967012

Cited by 8 publications

(6 citation statements)

References 2 publications

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“…Sohendra et al [10] first reported in 1986 that bleeding from GV could be controlled by sclerotherapy using the tissue adhesive agent butyl cyanoacrylate. Since then several authors have used different sclerosing agents to achieve hemostasis in bleeding gastric varices, including N-butyl-2 cyanoacrylate (histoacryl) [11,12] , 2-octyl cyanoacrylate [13] , ethanolamine oleate injection [14] , gastric variceal banding [15] , thrombin [1] and sodium tetradecyl sulfate [16] . However, N-butyl 2 cyanoacrylate (NBC) is the only promising agent.…”

Section: Introductionmentioning

confidence: 99%

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

Wang¹,

Cheng²,

Li³

et al. 2009

WJG

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AIM:To investigate glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding and to evaluate the long-term efficacy and safety of this therapy. METHODS:A total of 148 cirrhotic patients in our hospital with esophagogastric variceal bleeding (EGVB) were included in this study. N-butyl-2-cyanoacrylate was mixed with lipiodol in a 1:1 ratio and injected as a bolus of 1-3 mL according to variceal size. Patients underwent endoscopic follow-up the next week, fourth week, second month, fourth month, and seventh month after injection and then every 6 mo to determine the cast shape. An abdominal X-ray film and ultrasound or computed tomographic scan were also carried out in order to evaluate the time of variceal disappearance and complete extrusion of the cast. The average follow-up time was 13.1 mo. RESULTS:The instantaneous hemostatic rate was 96.2%. Early re-bleeding after injection in 9 cases (6.2%) was estimated from rejection of adhesive. Late re-bleeding occurred in 12 patients (8.1%) at 2-18 mo. The glue cast was extruded into the lumen within one month in 86.1% of patients and eliminated within one year. Light erosion was seen at the injection position and mucosa edema in the second week. The glue casts were extruded in 18 patients (12.1%) after one week and in 64 patients (42.8%) after two weeks. All kinds of glue clumping shapes and colors on endoscopic examination were observed in 127 patients (86.1%) within one month, including punctiform, globular, pillar and variform. Forty one patients (27.9%) had glue extrusion after 3 mo and 28 patients (28.9%) after six months. The extrusion time was not related to the injection volume of histoacryl. Obliteration was seen in 70.2% (104 cases) endoscopically. The main complication was re-bleeding resulting from extrusion. The prognosis of the patients depended on the severity of the underlying liver disease. CONCLUSION:Endoscopic injection of cyanoacrylate is highly effective for gastric varices bleeding. The glue clump shape is correlated with anatomic structure of vessels. The time of extrusion was not related to dosage of the glue.

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Section: Introductionmentioning

confidence: 99%

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

Wang¹,

Cheng²,

Li³

et al. 2009

WJG

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“…In previously published studies concerning application of cyanoacrylate in non-variceal gastrointestinal bleeding, the glue was injected directly into the area of bleeding [ 16 , 17 ] or sprayed over the bleeding lesion [ 13 – 15 ]. Injection of cyanoacrylate into the blood vessel raises a concern about thromboembolic complications [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding.

Kurek¹,

Baniukiewicz²,

Świdnicka-Siergiejko³

et al. 2014

Videosurgery and Other Miniinvasive Techniques

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Gastrointestinal bleeding is a common medical emergency. Although endoscopic treatment is effective in controlling non-variceal upper gastrointestinal bleeding, in cases of persistent bleeding radiological or surgical interventions are required. Application of cyanoacrylate for treatment of difficult-to-arrest non-variceal upper gastrointestinal bleeding is poorly investigated. We describe patients in whom cyanoacrylate for acute non-variceal gastrointestinal bleeding was used to stop the bleeding after failure of conventional endoscopic treatment. Five patients were treated with cyanoacrylate application (injection and/or spraying) for persistent bleeding (duodenal ulcer in 3, gastric ulcer in 1 and gastric Dieulafoy's lesion in 1) despite conventional endoscopic therapies. Hemostasis was achieved in all patients (100%). One patient (20%) developed recurrent bleeding 4 days after initial treatment. No complications or adverse events attributed to the cyanoacrylate application during the follow-up period of 57 days were observed. Application of cyanoacrylate is a safe and effective method to achieve immediate hemostasis when conventional endoscopic treatment is unsuccessful. This technique is easy to perform and should be considered in cases of patients with difficult-to-arrest acute non-variceal upper gastrointestinal bleeding.

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“…Giant ulceration at the site of injection has been ascribed to paravariceal or intramural glue injection. 69 At times, ulceration may involve the full thickness of the esophagus and result in sinus formation from the esophageal wall. 70 Impaction of the needle tip in the glue cast was reported with the use of undiluted glue for active bleeding and was attributed to premature glue solidification in the tip of the injector.…”

Section: Local Complicationsmentioning

confidence: 99%

Gluing Gastric Varices in 2012: Lessons Learnt Over 25 Years

Saraswat¹,

Verma²

2012

Journal of Clinical and Experimental Hepatology

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Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consensus has been reached on the best way for treating these patients. Gastric variceal obturation (GVO) with the tissue adhesive, N-2-butyl-cyanoacrylate (NBC), is considered the treatment of first-choice for this condition in most parts of the world. The liquid monomer polymerizes into a solid cast, obturating the vessel within 10-20 s of coming in contact with ionic solutions such as blood. Gastric variceal obturation achieves hemostasis in over 90% of patients with active bleeding, eradicates GV in over 80% of these patients, and re-bleeding occurs in 3-30%. These results are comparable with those of transjugular intrahepatic portosystemic shunting (TIPS; over 90% hemostasis in acute bleeding with re-bleeding in 15-30%). Though, there has been no direct comparison with GVO, balloon-occluded retrograde transvenous obliteration of GV (BRTO) achieves near 100% obliteration with recurrence in 0-10% and is superior to TIPS for hemostasis in active bleeding when used in combination with transcatheter sclerotherapy. Several complications have been described for GVO including thromboembolic complications which occur in 0.5-4.3% and may be devastating in some. Many of the complications and the variability in results of GVO can be attributed to variations in injection technique. The use of a standardized injection technique has been reported to achieve 100% hemostasis and obliteration with 6.9% re-bleeding and no embolic complications. Gastric variceal obturation with NBC continues to be the first-choice therapy for GV bleeding outside Japan. Adherence to a standard injection technique will maximize hemostasis and eradication of GV while minimizing complications of therapy.

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Successful treatment of a giant exposed blood vessel in a gastric ulcer by endoscopic sclerotherapy with N-butyl-2-cyanoacrylate

Cited by 8 publications

References 2 publications

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding.

Gluing Gastric Varices in 2012: Lessons Learnt Over 25 Years

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