title: Systematic review of cyanoacrylate embolization for refractory gastrointestinal fistulae: a promising therapy.
abstract: BACKGROUND
  Surgical management of gastrointestinal fistulae has been reported to carry a 30-day morbidity rate up to 82% and a mortality rate ranging from 2% to 4.8%; thus nonoperative alternatives are required. The aim of the present study was to assess the current experience on the use of cyanoacrylates in the management of these fistulae.
  
  
  METHODS
  A systematic review was carried out on Medline, Embase, The Cochrane database, Academic Search Complete, MedicLatina, and SciELO for English, Spanish, and Portuguese articles dealing with refractory fistulae by means of cyanoacrylate embolization therapy. Publication dates were restricted from 1969 to present. Outcome parameters were study design, number of participants, etiology of the fistula, approach, material used, success rate, complications, and mortality.
  
  
  RESULTS
  Electronic search yielded a total of 377 articles. After a meticulous screening, only 14 studies dealing with foregut/midgut fistulae and 6 addressing hindgut fistulae were included. All the included articles were prospective and retrospective case series. Cumulative success rate was 81% (range 0% to 100%) and 3 out of 203 patients (1%) developed minor complications.
  
  
  CONCLUSIONS
  Cyanoacrylate embolization of nearly all types of refractory gastrointestinal fistulae is a feasible and harmless technique. Prospective controlled studies are required to support the available evidence.
authors.affiliation: Mexican Institute for Social Security, HGZ 11, Delicias, Mexico juliocesar1701@icloud.com.
authors.forename: Julio
authors.initials: J
authors.lastname: López
authors.affiliation: Mexican Institute for Social Security, HGZ 11, Delicias, Mexico.
authors.forename: Karime
authors.initials: K
authors.lastname: Rodriguez
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.affiliation: Mexican Institute for Social Security, UMAE 25, Monterrey, Mexico.
authors.forename: Heber
authors.initials: H
authors.lastname: Guzman
authors.affiliation: Mexican Institute for Social Security, HGZ 6, Juarez, Mexico.
authors.forename: Iván
authors.initials: I
authors.lastname: Corral
authors.affiliation: Mexican Institute for Social Security, Chihuahua, Mexico.
authors.forename: Rene
authors.initials: R
authors.lastname: Gameros
authors.affiliation: Mexican Institute for Social Security, Chihuahua, Mexico.
authors.forename: Arturo
authors.initials: A
authors.lastname: Reyes
mesh_terms: D003487:Cyanoacrylates / Q000009:adverse effects / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D005747:Gastric Fistula / Q000628:therapy*; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy*; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C421461:glubran 2
keywords: 2-octyl cyanoacrylate; Glubran 2; cyanoacrylates; embolization therapy; enterocutaneous; gastrointestinal fistula