title: Endoscopic hemostasis with fibrin glue for refractory postsphincterotomy and postpapillectomy bleeding.
abstract: BACKGROUND
  Bleeding is a feared complication of endoscopic sphincterotomy and papillectomy. Fibrin glue has been proposed as an effective adjunct in securing hemostasis. However, its use has been limited by the risk of early occlusion of the injecting needle, and its role has not been defined in the setting of refractory post-ERCP bleeding. We present a modified technique of endoscopic hemostasis with diluted fibrin glue in the setting of postsphincterotomy and postpapillectomy bleeds.
  
  
  OBJECTIVE
  We aimed to verify that diluted fibrin glue can be easily and successfully injected and is effective in the endoscopic treatment of refractory post-ERCP bleeding.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A tertiary-care academic medical center.
  
  
  METHODS
  Six patients with refractory post-ERCP bleeding were treated (3 after sphincterotomy and 3 after papillectomy) with fibrin glue injection.
  
  
  METHODS
  Endoscopic hemostasis with diluted fibrin glue injection.
  
  
  METHODS
  Successful endoscopic hemostasis with diluted fibrin glue injection.
  
  
  RESULTS
  One session of fibrin glue injection stopped the refractory post-ERCP bleeding in all 6 patients.
  
  
  CONCLUSIONS
  Small number of patients.
  
  
  CONCLUSIONS
  This case series provides evidence that our modified injection technique of diluted fibrin glue allowed an easy submucosal injection and may be considered to be an effective endoscopic modality to treat refractory post-ERCP bleeding.
authors.affiliation: Digestive Endoscopy Unit, Department of Surgery, Sacro Cuore Catholic University, Rome, Italy. massimiliano.mutignani@rm.unicatt.it
authors.forename: M
authors.initials: M
authors.lastname: Mutignani
authors.forename: T
authors.initials: T
authors.lastname: Seerden
authors.forename: A
authors.initials: A
authors.lastname: Tringali
authors.forename: D
authors.initials: D
authors.lastname: Feisal
authors.forename: V
authors.initials: V
authors.lastname: Perri
authors.forename: P
authors.initials: P
authors.lastname: Familiari
authors.forename: G
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004384:Duodenoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D042882:Gallstones / Q000601:surgery; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D010183:Pancreatic Ducts / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic
chemical_list: D015718:Fibrin Tissue Adhesive