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

• Published in: World journal of gastroenterology : WJG 2016-12, Vol.22 (48), p.10609-10616
• Main Authors: Grassia, Roberto, Capone, Pietro, Iiritano, Elena, Vjero, Katerina, Cereatti, Fabrizio, Martinotti, Mario, Rozzi, Gabriele, Buffoli, Federico
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cyanoacrylates - administration & dosage; Cyanoacrylates - adverse effects; Cyanoacrylates - therapeutic use; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - surgery; Gastrointestinal Hemorrhage - therapy; Hemostasis, Endoscopic - methods; Humans; Injections - adverse effects; Male; Middle Aged; Practice Guidelines as Topic; Retreatment - methods; Retrospective Studies; Retrospective Study; Treatment Outcome; Upper Gastrointestinal Tract - pathology; Upper Gastrointestinal Tract - surgery
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i48.10609

AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal 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 initialhemostasis 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.