N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.
References
-
1
Berg P L, Barina W, Born P.
Endoscopic injection of fibrin glue versus polidocanol in peptic ulcer hemorrhage: a pilot study.
Endoscopy.
1994;
26
528-530
-
2
Gotlib J P, Demma I, Fonsecca A, et al.
Résultats à 1 an du traitement endoscopique élective des hémorragies par rupture de varices oesophagiennes chez le cirrhotique.
Gastroenterol Clin Biol.
1984;
8
133
-
3
Kok K YY, Kum C K, Goh P MY.
Endoscopic hemostasis of upper gastrointestinal bleeding with Histoacryl: last resort before surgery.
Endoscopy.
1996;
28
256-258
-
4
Feretis C, Tabakopoulos D, Benakis P, et al.
Endoscopic hemostasis of esophageal and gastric variceal bleeding with Histoacryl.
Endoscopy.
1990;
22
282-284
-
5
Coover H W, Joyner F B, Shearer N H, Wicker T H.
Chemistry and performance of cyanoacrylate adhesives.
J Soc Plast Eng.
1959;
15
413-417
-
6
Leonard F, Kulkarmi R K, Brandes G, et al.
Synthesis and degradation of poly(alkyl-a-cyanoacrylate).
J Appl Polym Sci.
1996;
10
259-272
-
7
D'Imperio N, Papadia D, Baroncini D, et al.
N-butyl-2-cyanoacrylate in the endoscopic treatment of dieulafoy ulcer.
Endoscopy.
1995;
27
216
-
8
Binmoeller K F, Soehendra N.
Superglue: the answer to variceal bleeding and fundal varices?.
Endoscopy.
1995;
27
392-396
-
9
Lee K J, Hwang I R, Hahm K B, et al.
Randomized trial of Histoacryl injection compared with fibrin glue injection in treatment of bleeding peptic ulcer.
Gastrointest Endosc.
1999;
49
4
-
10
Naga M, El-Fiki A.
Classification and management of gastric varices.
Sci J Cai Med Synd.
1993;
5
137-139
-
11
Fabriani B, Degott C, Ramond M J, et al.
Endoscopic obturation of oesophagogastric varices with Bucrylate, 2: morphological study based on 12 autopsy cases.
Gastroenterol Clin Biol.
1986;
10
580-583
-
12
Soehendra N, Grimm H, Maydeo A, et al.
Endoscopic obliteration of fundal varices.
Can J Gastroenterol.
1990;
4
643-646
-
13
See A, Florent C, Lamy F, et al.
Cerebrovascular accident after endoscopic obliteration of oesophageal varices with isobutyl-2-cyanoacrylate in 2 patients.
Gastroenterol Clin Biol.
1986;
10
604-607
-
14
Vallieres D, Jamieson C, Harbar G B, Mackensie R L.
Pancreatoduodenal necrosis after endoscopic injection of cyanoacrylate to treat a bleeding duodenal ulcer; a case report.
Surgery.
1989;
106
901-903
-
15
Benedetti G, Sablich R, Lacchin T, Masiero A.
Endoscopic treatment of bleeding duodenal varices by bucrylate injection.
Endoscopy.
1993;
25
432-433
M.D. J. H. Kim
Dept. of Gastroenterology Ajou University School of Medicine
San 5, Wonchon-Dong
Paldal-Gu, Suwon 442-749
South Korea
Telefon: +82-331-219-5999
eMail: jinhkim@netsgo.com
