Systematic Review of Cyanoacrylate Embolization for Refractory Gastrointestinal Fistulae

López, Julio; Rodriguez, Karime; Targarona, Eduardo M.; Guzman, Heber; Corral, I. Alejandro; Gameros, Rene; Reyes, Alicia Georgina Siordia

doi:10.1177/1553350614535860

Cited by 23 publications

(14 citation statements)

References 42 publications

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“…Although our results were obtained from a retrospective series, in our opinion, it would be possible to hypothesize that the lack of complications might be at least partly derived from our long experience in treating variceal bleeding with this product that has been largely documented in digestive endoscopy[29,32-34]. …”

Section: Discussionmentioning

confidence: 99%

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

Grassia¹,

Capone²,

Iiritano³

et al. 2016

WJG

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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.

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Section: Discussionmentioning

confidence: 99%

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

Grassia¹,

Capone²,

Iiritano³

et al. 2016

WJG

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“…Avalos-Gonzalez et al reported earlier fistula closure and decreased morbidity in the fibrin-treated group compared to controls [ 54 ]. A meta-analysis reviewing 14 studies that evaluated the efficacy of cyanoacrylate reported a success rate of 81% [ 55 ]. Despite the high success rate, high-output gastrointestinal fistulas are less likely to be successfully closed by sealant alone.…”

Section: Individual Endoscopic Techniquesmentioning

confidence: 99%

Gastrointestinal fistula endoscopic closure techniques

Bhurwal

Mutneja

Tawadross

et al. 2020

aog

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With the improvement in flexible endoscopic technology and the availability of new endoscopic devices, current endoscopic therapies spare many patients who would otherwise undergo surgical repair of gastrointestinal fistulas. These endoscopic techniques include gastrointestinal stents, endoscopic suturing, cardiac septal occluders, endo-sponge, vacuum therapy and others. This review elaborates on the indications, evidence, procedural details, efficacy, and complications of various endoscopic techniques for the management of gastrointestinal fistulas.

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“…For surgical treatment of patients with intestinal fistula must be carried nutritional recovery, replacement and stabilization of electrolytes, identification of the fistulous path, drainage adjacent and along the fistula and abscess to allow full closure thereof and the abdominal wall. [59,60]. Depending on the site of the fistula, replacement of fistula output varies.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…Normal intestinal motility and function generally return once abdominal sepsis is controlled and fluid and electrolyte imbalances are corrected. If the fistula location is such that enteric access and alimentation are possible, enteral nutrition can be instituted and parenteral nutrition phased out [59]. By using a combination of approaches, adequate nutrition can be maintained throughout the patient's course [1].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…The insertion of a catheter allows control of debt and exchange, in the case of fistula, catheter progressively smaller caliber with treatment, follows the path of healing and the evolution of the case [58]. Enteral nutrition should be initiated as soon as possible in patients with a risk factor for fistula, since it constitutes a protective factor [59]. For early anastomotic dehiscence and great debt fistulas, the surgical management is the best option.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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Digestive Fistulas: The Challenge Continues

Filho¹,

Rêgo²

2016

Transl Biomed

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The digestive fistulas correspond to abnormal communications between the digestive system and between this and the body surface. Even after many years of study on the subject, digestive fistulas continue to challenge surgeons and patients suffering harm, consuming fortunes in their treatment, as well as causing serious damage affected people, its due to high morbidity and mortality. This review aims to review the literature on the gastrointestinal fistula subject, focusing on etiology, pathophysiology, classification, diagnosis, current therapy and prognosis in order to revisit a highly important topic and continue helping clinicians, general surgeons and device digestive in combating this challenge for doctors and patients.

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Systematic Review of Cyanoacrylate Embolization for Refractory Gastrointestinal Fistulae

Abstract: Cyanoacrylate embolization of nearly all types of refractory gastrointestinal fistulae is a feasible and harmless technique. Prospective controlled studies are required to support the available evidence.

Cited by 23 publications

References 42 publications

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

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

Gastrointestinal fistula endoscopic closure techniques

Digestive Fistulas: The Challenge Continues

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