Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10609-10616
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10609
Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate
Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Mario Martinotti, Gabriele Rozzi, Federico Buffoli
Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, “ASST di Cremona”, 26100 Cremona, Italy
Mario Martinotti, Department of Surgery, “ASST di Cremona”, 26100 Cremona, Italy
Gabriele Rozzi, Department of Radiology, “ASST di Cremona”, 26100 Cremona, Italy
Author contributions: Grassia R and Buffoli F designed the research and analyzed the data; Grassia R, Capone P, Iiritano E, Vjero K, Cereatti F, Martinotti M, Rozzi G and Buffoli F performed the research; Grassia R wrote the paper.
Institutional review board statement: For retrospective studies, Italian law (Official Gazette n. 76 of 31/03/2008) only requires notification to the Local Ethical Committee.
Informed consent statement: According to Italian law (01/03/2012, published on Official Gazette n.72 of March 26, 2012), there is no need to request informed consent for retrospective studies using anonymized data and not including genetic data.
Conflict-of-interest statement: There are no conflicts of interest to be disclosed.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto Grassia, MD, Dirigente Medico I livello, Digestive Endoscopy and Gastroenterology Unit, “ASST di Cremona”, Viale Concordia n 1, 26100 Cremona, Italy. robertograssia@yahoo.it
Telephone: +39-372-405255 Fax: +39-372-405254
Received: July 25, 2016
Peer-review started: July 27, 2016
First decision: September 28, 2016
Revised: October 13, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: December 28, 2016
Processing time: 154 Days and 13.6 Hours
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: Rescue treatment; Glubran; Non-variceal upper gastrointestinal bleeding; Endoscopic treatment; Cyanoacrylate

Core tip: Endoscopic hemostasis methods are very effective for managing non-variceal upper gastrointestinal bleeding (NV-UGIB), but an early rebleeding rate of approximately 10% reduces the success of initial hemostasis. A modified cyanoacrylate (NBCA + MS) glue used for variceal bleeding has occasionally also been used to treat NV-UGIB. In our 7 years of experience, 33 patients were treated with NBCA + MS after conventional treatment modalities failed. Hemostasis was achieved in approximately 80% of these patients. Modified cyanoacrylate effectively treated NV-UGIB after the failure of conventional treatment modalities.