Submucosal Fibrin Adhesion in Upper Gastrointestinal Bleeding
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.
KeywordsCatheter Adrenaline Omeprazole Ranitidine Angiodysplasia
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