Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis.
BACKGROUND
Endoscopic therapy is a safe and effective method for treating non-variceal upper gastrointestinal bleeding. However failure of therapy, in terms of continuing bleeding or rebleeding, is seen in up to 20%. Cyanoacrylate is a tissue glue used for variceal bleeding that has occasionally been reported as an alternative haemostatic technique in non-variceal haemorrhage.


OBJECTIVE
To retrospectively describe personal experience using cyanoacrylate injection in the management of bleeding ulcers after failure of first-line endoscopic modalities.


METHODS
Between January 1995 and March 1998, 18 [12 M/6 F, mean age 68.1 years) out of 176 patients, referred to our Unit for non-variceal upper gastrointestinal bleeding, were treated with intralesional injection of adrenaline plus undiluted cyanoacrylate. Persistent bleeding after endoscopic haemostasis or early rebleeding were the indications for cyanoacrylate treatment.


RESULTS
Definitive haemostasis was achieved in 17 out of 18 patients treated with cyanoacrylate. One patient needed surgery. No early or late rebleeding occurred during the follow-up. No complications or instrument lesions related to cyanoacrylate were recorded.


CONCLUSIONS
In our retrospective series, cyanoacrylate plus adrenaline injection was found to be a potentially safe and effective alternative to endoscopic haemostasis when conventional treatment modalities fail in controlling bleeding from gastroduodenal ulcers.
Department of Gastroenterology, Endoscopy Unit, Molinette Hospital, Turin, Italy. endoaleit@hotmail.com
A
A
Repici
A
A
Ferrari
C
C
De Angelis
S
S
Caronna
C
C
Barletti
S
S
Paganin
A
A
Musso
P
P
Carucci
W
W
Debernardi-Venon
M
M
Rizzetto
G
G
Saracco
D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage* / Q000627:therapeutic use; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D016558:Hemostasis, Endoscopic; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*
D003487:Cyanoacrylates; D004837:Epinephrine