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

  • Vascular-Interventional
  • Published:
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Abstract

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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Abbreviations

CI:

Confidence interval

CT:

Computed tomography

EVOH:

Ethylene-vinyl alcohol

GDA:

Gastroduodenal artery

INR:

International normalized ratio

LGA:

Left gastric artery

LGEA:

Left gastroepiploic artery

NBCA-MS:

N-butyl cyanoacrylate metacryloxysulfolane

NSAID:

Non-steroidal anti-inflammatory drug

PRBCs:

Packed red blood cells

RGA:

Right gastric artery

RGEA:

Right gastroepiploic artery

SD:

Standard deviation

SIR:

Society of Interventional Radiology

SMA:

Superior mesenteric artery

TAE:

Transcatheter arterial embolization

UGIB:

Upper gastrointestinal bleeding

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France

    Romaric Loffroy, Anne-Solène Desmyttere, Julie Pellegrinelli, Nicolas Falvo, Marco Midulla & Olivier Chevallier

  2. Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079, Dijon Cedex, France

    Romaric Loffroy

  3. Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France

    Thomas Mouillot, Antoine Drouilllard & Marc Bardou

  4. Department of Digestive and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France

    Olivier Facy

  5. Department of Anesthesia and Intensive Care, François-Mitterrand University Hospital, Dijon, France

    Pierre-Emmanuel Charles

  6. Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France

    Serge Aho-Gléglé

Authors
  1. Romaric Loffroy
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  2. Anne-Solène Desmyttere
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Corresponding author

Correspondence to Romaric Loffroy.

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Guarantor

The scientific guarantor of this publication is Romaric Loffroy.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise: Serge Aho-Gléglé, MD, Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France.

Informed consent

Written informed consent was not required for this study because of the retrospective nature of the study in an emergency setting.

Ethical approval

Institutional Review Board approval was not required because of the retrospective nature of the study in an emergency setting.

Methodology

• retrospective

• case-control study

• observational

• performed at one institution

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Loffroy, R., Desmyttere, AS., Mouillot, T. et al. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur Radiol 31, 3015–3026 (2021). https://doi.org/10.1007/s00330-020-07427-y

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  • DOI: https://doi.org/10.1007/s00330-020-07427-y

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