Glue embolization for endoscopically unmanageable gastrointestinal haemorrhage

Background/Aims: To evaluate the clinical feasibility of embolization with n-butyl cyanoacrylate (NBCA) for endoscopically unmanageable non-variceal gastro-intestinal hemorrhage (GIH). Methodology: Between June 2004 and May 2009, 61 patients with confirmed acute upper and/or lower GIH underwent emergency embolization for haemorrhage control; NBCA was used in 28 of these patients, all of whom were in shock despite receiving blood transfusions. The results were studied retrospectively. Clinical parameters and embolization data were assessed for technical success, clinical success and outcome. Results: Technical success was achieved in all patients. Clinical success was achieved in 19 (68%) of the 28 patients. The mortality rate was 25% (7 patients). The cause of death was disseminated intravascular coagulation (DIC) in 6 patients and heart failure in 1. The presence of coagulopathy or DIC significantly decreased the degree of clinical success (p=0.015, p=0.001, respectively) and increased the mortality rate (p=0.013, p<0.001, respectively). Unfortunately, 86% patients who had DIC before embolization, died. Conclusions: NBCA embolization is technically feasible and is effective for the control of haemorrhage in endoscopically unmanageable GIH. However, the presence of coagulopathy or DIC significantly decreases the clinical success and increases the mortality rate.