Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 28;22(48):10609-10616.
doi: 10.3748/wjg.v22.i48.10609.

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

Roberto Grassia  1 , Pietro Capone  1 , Elena Iiritano  1 , Katerina Vjero  1 , Fabrizio Cereatti  1 , Mario Martinotti  1 , Gabriele Rozzi  1 , Federico Buffoli  1
Affiliations

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

Roberto Grassia et al. World J Gastroenterol. .

Abstract

Aim: To 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).

Methods: In 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.

Results: Of 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.

Conclusion: Modified 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.

Keywords: Cyanoacrylate; Endoscopic treatment; Glubran; Non-variceal upper gastrointestinal bleeding; Rescue treatment.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to be disclosed.

Figures

Figure 1
Figure 1
Treated patient results: Successes and failures. NV-UGIB: Non-variceal upper gastrointestinal bleeding; NBCA + MS: N-butyl-2-cyanoacrylate associated with methacryloxysulfolane; TAE: Transarterial embolization.
Figure 2
Figure 2
A duodenal bleeding ulcer (Forrest type Ib) (A); endoscopic hemostasis achieved with cyanoacrylate (B); and injection site evaluation after 3 d (C).
See this image and copyright information in PMC

References

    1. Palmer K. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut. 2002;51 Suppl 4:iv1–iv6. - PMC - PubMed
    1. Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc. 2004;59:788–794. - PubMed
    1. Palmer K. Acute upper gastrointestinal haemorrhage. Br Med Bull. 2007;83:307–324. - PubMed
    1. Jiranek GC, Kozarek RA. A cost-effective approach to the patient with peptic ulcer bleeding. Surg Clin North Am. 1996;76:83–103. - PubMed
    1. Kaplan RC, Heckbert SR, Koepsell TD, Furberg CD, Polak JF, Schoen RE, Psaty BM. Risk factors for hospitalized gastrointestinal bleeding among older persons. Cardiovascular Health Study Investigators. J Am Geriatr Soc. 2001;49:126–133. - PubMed

Publication types

MeSH terms