Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents View Full Text


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Article Info

DATE

2020-10-31

AUTHORS

Romaric Loffroy, Anne-Solène Desmyttere, Thomas Mouillot, Julie Pellegrinelli, Olivier Facy, Antoine Drouilllard, Nicolas Falvo, Pierre-Emmanuel Charles, Marc Bardou, Marco Midulla, Serge Aho-Gléglé, Olivier Chevallier

ABSTRACT

ObjectivesTo compare our experience with N-butyl cyanoacrylate glue as the primary embolic agent versus other embolic agents for transcatheter arterial embolization (TAE) in refractory peptic ulcer bleeding and to identify factors associated with early rebleeding and 30-day mortality.MethodsRetrospective study of 148 consecutive patients comparing the clinical success rate in 78 patients managed with Glubran®2 N-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) alone or with other agents and 70 with other embolic agents only (coils, microspheres, ethylene-vinyl alcohol copolymer, or gelatin sponge) at a university center in 2008–2019. Univariate and multivariate logistic regression analyses were done to identify prognostic factors.ResultsThe technical success rate was 95.3% and the primary clinical success was 64.5%. The early rebleeding and day-30 mortality rates were 35.4% and 21.3%, respectively. Rebleeding was significantly less common with than without Glubran®2 (OR, 0.47; 95% CI, 0.22–0.99; p = .047) and significantly more common with coils used alone (OR, 20.4; 95% CI, 10.13–50.14; p = .024). The only other factor independently associated with early rebleeding was having two or more comorbidities (OR, 20.14; 95% CI, 10.01–40.52; p = .047). Day-30 mortality was similar in the two treatment groups. A lower initial hemoglobin level was significantly associated with higher day-30 mortality (OR, 10.38; 95% CI, 10.10–10.74; p = .006). Fluoroscopy time was significantly shorter with Glubran®2 (20.8 ± 11.5 min vs. 35.5 ± 23.4 min, p = .002). Both groups (Glubran®2 vs. other agents) had similar rates of overall complications (10.7% vs. 9.1%, respectively, p = .786).ConclusionsGlubran®2 NBCA-MS as the primary agent allowed for faster and better clinical success compared to other embolic agents when used for TAE to safely stop refractory peptic ulcer bleeding.Key Points• Choice of embolic agent for arterial embolization of refractory peptic ulcer bleeding is still debated. We compared our experience with N-butyl cyanoacrylate (NBCA) glue vs. other embolic agents.• The use of Glubran®2 NBCA glue in the endovascular management of refractory peptic ulcer bleeding was significantly faster and more effective, and at least as safe compared to other embolic agents.• NBCA glue offers several advantages compared to other embolic agents and provides rapid hemostasis when used for arterial embolization to treat refractory peptic ulcer bleeding. It should be the first-line therapy. More... »

PAGES

3015-3026

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00330-020-07427-y

DOI

http://dx.doi.org/10.1007/s00330-020-07427-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1132233056

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/33128601


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19 schema:description ObjectivesTo compare our experience with N-butyl cyanoacrylate glue as the primary embolic agent versus other embolic agents for transcatheter arterial embolization (TAE) in refractory peptic ulcer bleeding and to identify factors associated with early rebleeding and 30-day mortality.MethodsRetrospective study of 148 consecutive patients comparing the clinical success rate in 78 patients managed with Glubran®2 N-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) alone or with other agents and 70 with other embolic agents only (coils, microspheres, ethylene-vinyl alcohol copolymer, or gelatin sponge) at a university center in 2008–2019. Univariate and multivariate logistic regression analyses were done to identify prognostic factors.ResultsThe technical success rate was 95.3% and the primary clinical success was 64.5%. The early rebleeding and day-30 mortality rates were 35.4% and 21.3%, respectively. Rebleeding was significantly less common with than without Glubran®2 (OR, 0.47; 95% CI, 0.22–0.99; p = .047) and significantly more common with coils used alone (OR, 20.4; 95% CI, 10.13–50.14; p = .024). The only other factor independently associated with early rebleeding was having two or more comorbidities (OR, 20.14; 95% CI, 10.01–40.52; p = .047). Day-30 mortality was similar in the two treatment groups. A lower initial hemoglobin level was significantly associated with higher day-30 mortality (OR, 10.38; 95% CI, 10.10–10.74; p = .006). Fluoroscopy time was significantly shorter with Glubran®2 (20.8 ± 11.5 min vs. 35.5 ± 23.4 min, p = .002). Both groups (Glubran®2 vs. other agents) had similar rates of overall complications (10.7% vs. 9.1%, respectively, p = .786).ConclusionsGlubran®2 NBCA-MS as the primary agent allowed for faster and better clinical success compared to other embolic agents when used for TAE to safely stop refractory peptic ulcer bleeding.Key Points• Choice of embolic agent for arterial embolization of refractory peptic ulcer bleeding is still debated. We compared our experience with N-butyl cyanoacrylate (NBCA) glue vs. other embolic agents.• The use of Glubran®2 NBCA glue in the endovascular management of refractory peptic ulcer bleeding was significantly faster and more effective, and at least as safe compared to other embolic agents.• NBCA glue offers several advantages compared to other embolic agents and provides rapid hemostasis when used for arterial embolization to treat refractory peptic ulcer bleeding. It should be the first-line therapy.
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26 schema:keywords Glubran
27 MethodsRetrospective study
28 N-butyl cyanoacrylate glue
29 NBCA glue
30 ObjectivesTo
31 University Center
32 advantages
33 agents
34 analysis
35 arterial embolization
36 bleeding
37 center
38 choice
39 clinical success
40 clinical success rate
41 coil
42 comorbidities
43 complications
44 consecutive patients
45 cyanoacrylate glue
46 day-30 mortality
47 day-30 mortality rate
48 early rebleeding
49 embolic agent
50 embolization
51 endovascular management
52 experience
53 factors
54 first-line therapy
55 fluoroscopy time
56 glue
57 good clinical success
58 group
59 hemoglobin levels
60 hemostasis
61 initial hemoglobin level
62 levels
63 logistic regression analysis
64 lower initial hemoglobin level
65 management
66 more comorbidities
67 mortality
68 mortality rate
69 overall complications
70 patients
71 peptic ulcer bleeding
72 primary agent
73 primary clinical success
74 primary embolic agent
75 prognostic factors
76 rapid hemostasis
77 rate
78 rebleeding
79 refractory peptic ulcer bleeding
80 regression analysis
81 similar rates
82 study
83 success
84 success rate
85 technical success rate
86 ten-year experience
87 therapy
88 time
89 transcatheter arterial embolization
90 treatment groups
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