title: Endoscopic management of refractory gastrointestinal non-variceal bleeding using Histoacryl (N-butyl-2-cyanoacrylate) glue.
abstract: BACKGROUND
  Histoacryl glue (N-butyl-2-cyanoacrylate) has well-established utility in the endoscopic management of gastrointestinal variceal bleeding. The role of Histoacryl glue in non-variceal bleeding is less clear, and there are few articles describing its use in this setting.
  
  
  METHODS
  Six patients with intractable non-variceal gastrointestinal bleeding were managed using injection of Histoacryl glue. All patients had previously failed conventional endostasis and/or interventional angioembolization and were not suitable for emergency salvage surgery due to serious comorbidities or unacceptable anaesthetic risk. An endoscopic Lipiodol-Histoacryl-Lipiodol sandwich injection technique was used in these patients. The clinical outcomes and complications were evaluated.
  
  
  RESULTS
  There were four females and two males with a mean age of 55 years. Bleeding lesions included gastric ulcers (n = 2), duodenal ulcers (n = 2), duodenal gastrointestinal stromal tumor (GIST) (n = 1) and rectal ulcers (n = 1). All patients had successful Histoacryl endostasis without the requirement for salvage surgery. There was no treatment-related morbidity and no mortality. Two patients had further bleeding after initial Histoacryl endostasis, which was successfully controlled with further endoscopic Histoacryl injection.
  
  
  CONCLUSIONS
  Histoacryl endostasis should be included in the treatment algorithm for refractory non-variceal gastrointestinal bleeding.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, Australia damienloh79@gmail.com.
authors.forename: Damien Ck
authors.initials: DC
authors.lastname: Loh
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, Australia.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wilson
keywords: Histoacryl glue; N-butyl-2-cyanoacrylate; endoscopy; non-variceal upper gastrointestinal bleeding