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Submucosal Fibrin Adhesion in Upper Gastrointestinal Bleeding

  • J. Labenz
  • U. Peitz
  • M. Wieczorek
  • G. Börsch
Conference paper

Abstract

During the past 15 years, several methods of endoscopic hemostasis have been evaluated in clinical studies, for injection therapy with adrenalin/polidocanol. However, these substances may produce tissue damage. In some pilot studies, excellent results concerning initial and definitive control of peptic ulcer hemorrhage were obtained with submucosal injection of a fibrin tissue adhesive.

In the past 2 1/2 years, 83 patients with upper gastrointestinal (GI) bleeding — peptic ulcer hemorrhage, n=68 (Forrest la, n=16; Ib, n=20; II a, n=29; II b, n=3); Mallory-Weiss tear, n=3; varices, n=3; esophageal ulcer/esophagitis, n=4; angiodysplasia, n=2; gastric carcinoma, n=1; and sphincterotomy bleeding, n=2 — diagnosed endoscopically were treated with a two-component fibrin adhesive (Tissucol Duo S, Immuno, Heidelberg, Germany) via a double lumen catheter. Initial control of bleeding was achieved in 96.4 % (80/83) of patients. Early rebleeding occurred in 11 out of 80 patients (13.8 %), which could be effectively managed by repeated injection of the fibrin adhesive in six patients. Nine patients (10.8%) required emergency (n=5) or elective surgery (n=4). The overall mortality rate was 6.0 %. Complications due to submucosal injection of the fibrin adhesive were not observed.

In conclusion, endoscopic submucosal injection of a fibrin adhesive was highly effective (96.4 % of patients) in initial control of upper GI hemorrhage predominantly due to peptic ulcer bleeding. By including repeated injections, definitive hemostasis was achieved in 90.4%. Prospective, randomized, and controlled studies are necessary to confirm these encouraging results.

Keywords

Peptic Ulcer Fibrin Sealant Submucosal Injection Endoscopic Hemostasis Double Lumen Catheter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • J. Labenz
  • U. Peitz
  • M. Wieczorek
  • G. Börsch

There are no affiliations available

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