Purpose: To compare our experience with N-butyl cyanoacrylate glue 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.
Material and 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 factors associated with early rebleeding and day-30 mortality.
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=0.047) and significantly more common with coils used alone (OR, 2.40; 95%CI, 1.13-5.14; P=0.024). The only other factor independently associated with early rebleeding was having two or more comorbidities (OR, 2.14; 95%CI, 1.01-4.52; P=0.047). Day-30 mortality was similar in the two treatment groups. A lower initial hemoglobin level was significantly associated with higher day-30 mortality (OR, 1.38; 95%CI, 1.10-1.74; P=0.006). Fluoroscopy time was significantly shorter with Glubran®2. Minor and major complications occurred in 5.6% and 4.3% of patients, respectively, with no significant difference between both groups.
Conclusions: Glubran®2 NBCA-MS was faster, more effective, and at least as safe compared to other embolic agents when used for TAE to treat refractory peptic ulcer bleeding.