title: Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Grassia
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Capone
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Iiritano
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Katerina
authors.initials: K
authors.lastname: Vjero
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cereatti
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Martinotti
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rozzi
authors.affiliation: Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", 26100 Cremona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Buffoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003487:Cyanoacrylates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000473:pathology* / Q000601:surgery
chemical_list: D003487:Cyanoacrylates; C421460:glubran
keywords: Cyanoacrylate; Endoscopic treatment; Glubran; Non-variceal upper gastrointestinal bleeding; Rescue treatment