Abstract
Background and Study Aims: The injection of fibrin tissue glue is a promising endoscopic method for hemostasis
of peptic ulcer bleeding. So far, no clinical study has focused on the ulcer healing
process after endoscopic fibrin injection.
Patients and Methods: A morphological study was performed on all resection specimens from patients operated
on between 1 January 1994 and 31 December 1996 for gastroduodenal ulcer bleeding with
prior endoscopic injection of fibrin glue. The fibrin clot was characterized histologically
for its size, location and aspect.
Results: Of 227 patients endoscopically treated with a double-lumen needle, 20 underwent resection.
The interval between fibrin injection and resection ranged from 6 hours to 9 days.
In 15 patients the ulcer was identified in the resection specimen. No fibrin remnants
were detectable in three, sparse fibrin deposits were seen in eight and large amounts
of fibrin were noted in the submucosa or subserosa in four specimens. With increasing
time, the clot was gradually organized by phagocytes and angio-fibroblasts and was
finally replaced by endogenous granulation tissue. An exuberant or tissue-destructive
reaction did not appear.
Conclusions: In this study, endoscopic fibrin sealing of bleeding ulcers resulted in appearance
of a bland fibroblast-rich granulation tissue. The depth of fibrin glue injection
is difficult to standardize with the aid of doublelumen needles.
