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.
KeywordsPeptic Ulcer Fibrin Sealant Submucosal Injection Endoscopic Hemostasis Double Lumen Catheter
Unable to display preview. Download preview PDF.
- 1.Berg P, Born P, Barina W, Simon W, Zellmer R, Paul F (1990) Fibrinkleber versus Polidocanol bei der oberen Gastrointestinalblutung. Z Gastroenterol 28: 467Google Scholar
- 4.Eimiller A, Berg P, Bor P, Barina W, Paul F, Homann H (1989) A new development in gastrointestinal bleeding: sclerotherapy using a fibrin sealant. In: Waclawiczek HW (ed) Progress in fibrin sealing. Springer, Berlin Heidelberg New York, pp 131–134Google Scholar
- 6.Friedrichs O (1992) Submucosal fibrin adhesion in peptic ulcer bleeding. Hellenic J Gastroenterol 5 [Suppl]: 86Google Scholar
- 8.Salm R, Sontheimer J, Laaff H, Cegla M (1989) Tissue reaction and hemostatic characteristics — fibrin sealant versus polidocanol: experimental and clinical results. In: Waclawiczek HW (ed) Progress in fibrin sealing. Springer, Berlin Heidelberg New York, pp 123–129Google Scholar
- 9.Strohm WD, Römmele UE, Barton E, Weimer J (1992) Fibrinklebung und konventionelle Injektionstherapie bei blutenden Ulzera im oberen GI-Trakt. Z Gastroenterol 30: 687Google Scholar