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Tytuł pozycji:

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

Tytuł:
Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents.
Autorzy:
Loffroy R; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France. .; Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079, Dijon Cedex, France. .
Desmyttere AS; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
Mouillot T; Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France.
Pellegrinelli J; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
Facy O; Department of Digestive and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France.
Drouilllard A; Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France.
Falvo N; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
Charles PE; Department of Anesthesia and Intensive Care, François-Mitterrand University Hospital, Dijon, France.
Bardou M; Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France.
Midulla M; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
Aho-Gléglé S; Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France.
Chevallier O; Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
Źródło:
European radiology [Eur Radiol] 2021 May; Vol. 31 (5), pp. 3015-3026. Date of Electronic Publication: 2020 Oct 31.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Original Publication: Berlin : Springer International, c1991-
MeSH Terms:
Embolization, Therapeutic*
Enbucrilate*
Peptic Ulcer*
Cyanoacrylates ; Humans ; Retrospective Studies ; Treatment Outcome
References:
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Contributed Indexing:
Keywords: Cyanoacrylates; Glubran 2; Humans; Peptic ulcer hemorrhage; Retrospective studies
Substance Nomenclature:
0 (Cyanoacrylates)
F8CEP82QNP (Enbucrilate)
Entry Date(s):
Date Created: 20201031 Date Completed: 20210415 Latest Revision: 20210415
Update Code:
20240105
DOI:
10.1007/s00330-020-07427-y
PMID:
33128601
Czasopismo naukowe
Objectives: To 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.
Methods: Retrospective 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.
Results: The 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).
Conclusions: Glubran®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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