Treatment of gastric varices with cyanoacrylate complicated by systemic embolization.

Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.

Securement of Umbilical Venous Catheter Using Cyanoacrylate Glue: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the role of cyanoacrylate glue in reducing dislodgement of umbilical venous catheters (UVCs). STUDY DESIGN: This was a single-center, randomized, controlled, nonblinded trial. All infants requiring an UVC according to our local policy were included in the study. Infants with a UVC with a centrally located tip as verified by real-time ultrasound examination were eligible for the study. Primary outcome was the safety and efficacy of securement by cyanoacrylate glue plus cord-anchored suture (SG group) vs securement by suture alone (S group), as measured by reduction in dislodgment of the external tract of the catheter. Secondary outcomes were tip migration, catheter-related bloodstream infection, and catheter-related thrombosis. RESULTS: In the first 48 hours after UVC insertion, dislodgement was significantly higher in the S group than in the SG group (23.1% vs 1.5%; P < .001). The overall dislodgement rate was 24.6% in the S group vs 7.7% in the SG group (P = .016). No differences were found in catheter-related bloodstream infection and catheter-related thrombosis. The incidence of tip migration was similar in both groups (S group 12.2% vs SG group 11.7%). CONCLUSIONS: In our single-center study, cyanoacrylate glue was safe and effective for securement of UVCs, and particularly effective in decreasing early catheter dislodgments. TRIAL REGISTRATION: UMIN-CTR Clinical Trial; Registration number: R000045844.

Un cuerpo extraño inusual de cianoacrilato en el oído. Presentación de un caso clínico y revisión de la literatura / An unusual cyanoacrylate foreign body in the ear. Presentation of a clinical case and literature review

El pegamento basado en cianoacrilato posee una gran capacidad de adherencia a los tejidos, representando un problema cuando se encuentra en el oído externo debido a sus características anatómicas particulares. Se presenta un caso clínico de cuerpo extraño de cianoacrilato que ocluye el conducto auditivo externo y el tímpano, alterando la audición. Se describen los hallazgos y los intentos de extracción utilizando las alternativas terapéuticas descritas en la literatura, sin obtener resultados positivos, debiendo recurrir a la extracción quirúrgica. Además, se presentan detalles del procedimiento y los resultados. El paciente recupera la audición y la normalidad anatómica.

Cyanoacrylate-based glue has a great capacity for adhering to tissue, which is a problem when it is placed in the ear canal due to the anatomy of this structure. A clinical case of a cyanoacrylate foreign body occluding the external auditory canal and the tympanic membrane is presented. The therapeutics alternatives described in the literature used in the case failed, so, it was surgically removed by drilling the glue. Details of the procedure and results are presented. The patient recovers the hearing and anatomical normality.

CYANOACRYLATE GLUE FOR GASTROESOPHAGEAL VARICES: A SINGLE CENTRE EXPERIENCE FROM NORTH INDIA.

BACKGROUND: In natural history of cirrhosis, variceal bleeding is one of the earliest decompensations to happen, and, if adequately managed, survival is improved. Gastric varices have challenges in management due to their location, size and propensity to bleed. The N-butyl 2-cyanoacrylate (NBC) glue application has emerged as definitive therapy in bleeding gastric varices. Here we present our experience with use of NBC in management of gastric and difficult cases of esophageal varices. METHODS: A total of 75 patients underwent NBC glue application for varices which included 69 patients with gastric varices and six patients with esophageal varices. All the procedures were done with flexible endoscope and sclerotherapy needle after due precautionary measures. RESULTS: Hemostasis was varices in all patients after endotherapy. The average quantity of glue used was 2.75±0.95 mL. Complete obliteration with single session of NBC application was achieved in 55 patients. Re-bleeding occurred in five patients within 5 days of index event. 20 patients had in-hospital mortality but none was related to gastrointestinal bleeding. 6-week all-cause mortality was 26 (35%). CONCLUSION: Glue therapy with NBC is a life saving therapy in patients with bleeding gastric varices and esophageal varices not amenable to endoscopic variceal ligation or sclerotherapy.

Cyanoacrylate glue in socket repair: a comparative study.

This study aimed to compare socket repair with Nylon 5-0 suture and closure using cyanoacrylate biological glue after tooth extraction. Twenty male Wistar rats, each weighing approximately 200 g were submitted to the extraction of the right and left first molar teeth. On the right side, the alveolus was closed with 2 ethyl-cyanoacrylate glue, whereas on the left side closure was with a single interrupted Nylon 5-0 suture (Ethilon). The animals were sacrificed after 3, 7, 15, and 30 postoperative days, and images of histological sections of the alveolus were captured for analysis. Histomorphometry was performed using Image J software to quantify bone neoformation in the alveolus. The results showed that on the seventh postoperative day the side treated with 2-ethyl-cyanoacrylate presented a delay in relation to the sutured side. However, on days 15 and 30, the difference in bone neoformation between gradually decreased until the thirtieth postoperative day, with no significant difference in bone neoformation in the last period of analysis. There was no difference between neoformation in the two sides (p = 0.902) after statistical analysis of the histomorphometric results. In conclusion, socket repair after alveolus closure with 2-ethyl-cyanoacrylate allows complete bone neoformation after tooth extraction, and there is no significant difference when compared with closure with Nylon 5-0.

Endoscopic Treatment of Gastric and Ectopic Varices.

Gastric variceal bleeding has a high mortality. Endoscopic cyanoacrylate injection is the standard therapy; however, rebleeding and unexpected adverse events, such as injection sites ulcers and distal glue embolisms, are pitfalls of this therapy. Endoscopic ultrasound (EUS)-guided endovascular therapies offer a safer and more practical alternative for the treatment of gastric varices. EUS-guided combined therapy with coiling and cyanoacrylate injection is the most promising alternative with high obliteration rates and fewer adverse events reported. The authors reviewed the latest available data for all endoscopic therapies proposed for the management of gastric varices in patients with chronic liver disease.

Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review.

To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE: Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS: The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS: Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.

Use of cyanoacrylate for the stabilization of tissues in root coverage procedures: A case series report with 5 years follow up

ABSTRACT: A variety of periodontal plastic surgery techniques have been proposed to correct aesthetic and functional problems caused by gingival recession, with root coverage using connective tissue grafts being the one most commonly performed. These surgeries, however, are partially dependent on tissue graft stability. In this case series, we describe the use of a tissue adhesive (cyanoacrylate) as a solution for graft stabilization. Two patients with Cairo's type 1 gingival recession were treated with an envelope technique using connective tissue graft stabilized with cyanoacrylate alone. The results were a faster procedure and complete root coverage, even after 5 years of follow-up. Our findings suggest that cyanoacrylates can be an alternative to standard graft stabilizing procedures, leading to a stable root coverage in RT1 recessions.

Effect of cyanoacrylate tissue adhesive in postoperative palatal pain management: a systematic review.

OBJECTIVE: To critically appraise available literature concerning the effect of cyanoacrylate tissue adhesive (CTA) in postoperative palatal pain management. MATERIALS AND METHODS: Electronic databases (Cochrane, PubMed, LILACS, Scopus, and Web of Science) were searched, complemented with grey literature databases up to June 2020. Studies reporting the effect of cyanoacrylate tissue adhesive compared to any other methods in postoperative palatal pain management were considered eligible. The risk of bias among and across included studies was assessed. RESULTS: Finally, four studies were considered eligible. Regarding free gingival graft (FGG), cyanoacrylate tissue adhesive with hemostatic sponge promoted less postoperative pain (PP) and analgesic consumption (AC). Also, cyanoacrylate tissue adhesive with platelet-rich fibrin produced less PP and more wound healing at the palatal area than cyanoacrylate tissue adhesive and wet gauze. Additionally, cyanoacrylate tissue adhesive promoted less PP and AC than wet gauze and suture. Concerning connective tissue graft (CTG), cyanoacrylate tissue adhesive, and suture produced similar PP, AC, and willingness for retreatment. CONCLUSIONS: Based on the low certainty level, cyanoacrylate tissue adhesive appears to promote less PP and AC than wet gauze and suture regarding FGG. Additionally, cyanoacrylate tissue adhesive appears to increase the effect of hemostatic sponge, contributing to the reduction of PP and AC. Regarding CTG, cyanoacrylate tissue adhesive appears to promote similar PP, AC, and willingness for retreatment than the suture. Therefore, cyanoacrylate tissue adhesive has shown promising usefulness for PP management in FGG, but not a clear benefit for CTG. CLINICAL RELEVANCE: The adoption of different agents for the protection of the palatal donor site following gingival harvesting procedures may provide better comfort to the patient.

Oclusión de la vena safena con cianocrilato, una alternativa para el tratamiento de insuficiencia venosa crónica. Experiencia inicial en el Instituto Guatemalteco de Seguridad Social ­ IGSS / Occlusion of the saphenous vein with cyanoacrylate, an alternative for the treatment of chronic venous insufficiency. Initial experience at the Guatemalan Social Security Institute - IGSS

Las técnicas de termo ablación han revolucionado el tratamiento de la insuficiencia venosa crónica, siendo actualmente el estándar de tratamiento. Con el avance tecnológico han surgido nuevas técnicas quirúrgicas, no térmicas, no tumescentes; como el uso de cianocrilato para la oclusión venosa, el cual ha demostrado ser seguro y eficaz en el tratamiento, y tener menos complicaciones posoperatorias. Objetivo: Describir la experiencia en nuestro hospital con el uso de cianocrilato para la oclusión de vena safena mayor para el tratamiento de insuficiencia venosa crónica. Describir la eficacia a corto y mediano plazo del cierre, las complicaciones y la mejoría de la sintomatología utilizando el cuestionario CIVIQ-20 y EVA. Material y métodos: Estudio retrospectivo observacional. Entre enero y diciembre de 2019 que incluye a pacientes con insuficiencia de unión safeno femoral, sintomáticos. Con diagnóstico mediante clasificación CEAP y ultrasonido Doppler. Seguimiento clínico y ecográfico valorando oclusión de los segmentos tratados y presencia de venas varicosas a los 3 y 6 meses. Se trataron 5 pacientes con oclusión venosa con cianocrilato (100% mujeres). Valoramos la calidad de vida mediante cuestionario CIVIQ-20 y EVA (Escala Analógica Visual) previo y un mes después del procedimiento. También se describe la tasa de éxito y complicaciones inmediatas y tardías. Resultados: La totalidad de los procedimientos se realizaron con anestesia local, siendo bien tolerados. Con un éxito inmediato del 100 % sin necesidad de conversión. Solo se presentó como complicación urticaria en un paciente en el trayecto de la vena tratada con cianocrilato, la cual se trató con esteroides y resolvió. El CIVIQ-20 mostró mejoría global pasando de 35 a 29 puntos en promedio; siendo el parámetro de actividad física el que mostró una mejoría mayor. EVA demostró que la pesadez (principal síntoma) se redujo un 67%. Durante el seguimiento, ningún caso presento repermeabilización o recanalizaciones segmentarias. Conclusiones: El tratamiento endovenoso de la insuficiencia venosa crónica con las nuevas técnicas no térmicas, no tumescentes es seguro y efectivo. A corto-mediano plazo ofrecen resultados similares a las técnicas termoablativas obviando el inconveniente de la tumescencia y el uso de medias compresivas en el posoperatorio, evitando lesiones térmicas y observándose mejoría en la sintomatología. (AU)

Thermo ablation techniques have revolutionized the treatment of chronic venous insufficiency, being currently the standard of treatment. With technological advancement, new non-thermal, non-tumescent surgical techniques have emerged; such as the use of cyanoacrylate for venous occlusion, which has been shown to be safe and effective in treatment, and have fewer postoperative complications. Objective: To describe the experience in our hospital with the use of cyanoacrylate for occlusion of the greater saphenous vein for the treatment of chronic venous insufficiency. Describe the shortand medium-term efficacy of closure, complications, and symptom improvement using the CIVIQ-20 questionnaire and VAS. Material and methods: Retrospective observational study. Between January and December 2019 that includes patients with symptomatic saphenous femoral junction insufficiency. With diagnosis by CEAP classification and Doppler ultrasound. Clinical and ultrasound follow-up evaluating occlusion of the treated segments and the presence of varicose veins at 3 and 6 months. 5 patients with venous occlusion were treated with cyanoacrylate (100% women). We assessed the quality of life using the CIVIQ-20 questionnaire and VAS (Visual Analogue Scale) before and one month after the procedure. The immediate and late success rate and complications are also described. Results: All the procedures were performed under local anesthesia, being well tolerated. With immediate 100% success without the need for conversion. Urticaria only presented as a complication in a patient in the path of the vein treated with cyanoacrylate, which was treated with steroids and resolved. The CIVIQ-20 showed global improvement, going from 35 to 29 points on average; being the physical activity parameter the one that showed the greatest improvement. VAS showed that heaviness (main symptom) was reduced by 67%. During follow-up, no case presented segmental recanalization or recanalization. Conclusions: Endovenous treatment of chronic venous insufficiency with new non-thermal, non-tumescent techniques is safe and effective. In the short-medium term, they offer results similar to thermoablative techniques, avoiding the inconvenience of tumescence and the use of compression stockings in the postoperative period, avoiding thermal injuries and observing improvement in symptoms. (AU)

Resección quirúrgica de tapón de cianoacrilato variceal infectado posterior a esclerosis endoscópica de várices gástricas. Caso clínico

In patients with actively bleeding gastric varices, the treatment of choice is the endoscopic use of sclerosing agents such as cyanoacrylate. We report a 69-year-old man who, after being treated with cyanoacrylate, suffered from recurrent febrile episodes. After an extensive study and broad-spectrum antibiotic treatment, discarding other presumably infectious focus, the superinfection of the cyanoacrylate plug was suspected, and its surgical removal was decided. A partial gastrectomy of the gastric fundus, a splenectomy, and a distal pancreatectomy were performed. The patient evolved without fever and without new episodes of bacteremia, but with decompensation of his cirrhosis manifested by ascites, spontaneous bacterial peritonitis, pneumonia, and collections in the pancreatic bed. These complications were managed with medical treatment consisting in a long course of broad-spectrum antibiotics. Thereafter, the patient evolved satisfactorily.

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial.

BACKGROUND: Gastric variceal bleeding is a life-threating condition with challenging management. We aimed to compare the efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization and cyanoacrylate injection versus EUS-guided coil embolization alone in the management of gastric varices. METHODS: A single-center, parallel-randomized controlled trial involving 60 participants with gastric varices (GOV II and IGV I) who were randomly allocated to EUS-guided coil embolization and cyanoacrylate injection (n = 30) or EUS-guided coil embolization alone (n = 30). The primary end points were the technical and clinical success rates of both procedures. The secondary end points were the reappearance of gastric varices during follow-up, along with rebleeding, the need for reintervention, and complication and survival rates. RESULTS: The technical success rate was 100 % in both groups. Immediate disappearance of varices was observed in 86.7 % of patients treated with coils and cyanoacrylate, versus 13.3 % of patients treated with coils alone (P < 0.001). Median survival time was 16.4 months with coils and cyanoacrylate versus 14.2 months with coils alone (P = 0.90). Rebleeding occurred in 3.3 % of patients treated with combined treatment and 20 % of those treated with coils alone (P = 0.04). With combined treatment, 83.3 % of patients were free from reintervention versus 60 % with coils alone (hazard ratio 0.27; 95 % confidence interval 0.095 - 0.797; P = 0.01). CONCLUSIONS: EUS-guided coil embolization with cyanoacrylate injection achieved excellent clinical success, with lower rates of rebleeding and reintervention than coil treatment alone. Multicenter studies are required to define the most appropriate technique for gastric variceal obliteration.

[Removal of an infected gastric cyanoacrylate plug. Report of one case]. / Resección quirúrgica de tapón de cianoacrilato variceal infectado posterior a esclerosis endoscópica de várices gástricas. Caso clínico.

In patients with actively bleeding gastric varices, the treatment of choice is the endoscopic use of sclerosing agents such as cyanoacrylate. We report a 69-year-old man who, after being treated with cyanoacrylate, suffered from recurrent febrile episodes. After an extensive study and broad-spectrum antibiotic treatment, discarding other presumably infectious focus, the superinfection of the cyanoacrylate plug was suspected, and its surgical removal was decided. A partial gastrectomy of the gastric fundus, a splenectomy, and a distal pancreatectomy were performed. The patient evolved without fever and without new episodes of bacteremia, but with decompensation of his cirrhosis manifested by ascites, spontaneous bacterial peritonitis, pneumonia, and collections in the pancreatic bed. These complications were managed with medical treatment consisting in a long course of broad-spectrum antibiotics. Thereafter, the patient evolved satisfactorily.

Surgical breast incisions treated with 2-octyl-cyanoacrylate versus intradermal nylon suture: a randomized clinical trial. / Incisões cirúrgicas mamárias tratadas com 2-octilcianoacrilato versus sutura intradérmica com fio de nylon: ensaio clínico randomizado.

OBJECTIVE: to evaluate the safety profile and aesthetic results of 2-octyl-cyanoacrylate versus intradermal nylon suture in breast surgeries. METHODS: an open-label, randomized, clinical trial evaluating the occurrence of complications, such as dehiscence, hematoma, infection, and allergic reactions after the use of 2-octyl-cyanoacrylate or nylon thread. The size of the incisions, skin closure time, and total surgical time were also analyzed. The aesthetic outcome was evaluated at 40 and 180 days after surgery, by means of the average width of the surgical wound and by subjective conceptual assessment (optimal, good, reasonable, or poor). RESULTS: 79 patients were included: 37 in the 2-octyl-cyanoacrylate group and 42 in the nylon suture group. The study was stopped before the end of patient recruitment due to the occurrence of a greater number of dehiscences in the adhesive group (OR: 11.42; 95%CI: 1.36-96.02; p=0.007). Regarding the other analyzed complications, the surgical duration and postoperative aesthetic result, no significant differences were observed between the groups. The mean operative wound size was greater in the adhesive group than in the suture group, but there was no correlation between wound size and the largest number of dehiscences. CONCLUSION: while the cosmetic outcomes with the two techniques were similar, there was a greater risk of dehiscence with the use of 2-octyl-cyanoacrylate compared to intradermal suturing.

OBJETIVO: avaliar o perfil de segurança e os resultados estéticos do 2-octilcianoacrilato versus sutura intradérmica com fio de nylon em cirurgias mamárias. MÉTODOS: ensaio clínico randomizado, aberto, que avaliou a ocorrência de complicações, como deiscência, hematoma, infecção e reações alérgicas após o uso do 2-octilcianoacrilato ou do fio de nylon. Também foi analisado o tamanho das incisões, o tempo de fechamento da pele e o tempo cirúrgico total. O resultado estético foi avaliado após 40 e 180 dias da cirurgia, por meio da largura média da ferida operatória e por avaliação subjetiva conceitual (ótimo, bom, razoável ou ruim). RESULTADOS: foram incluídas 79 pacientes, sendo 37 no grupo 2-octilcianoacrilato e 42 no grupo de sutura com fio de nylon. O estudo foi interrompido antes do término do recrutamento dos pacientes pela ocorrência de maior número de deiscências no grupo do adesivo (OR: 11,42; IC95%: 1,36-96,02; p=0,007). Em relação às demais complicações analisadas, ao tempo cirúrgico e ao resultado estético no pós-operatório, não se observaram diferenças significativas entre os grupos. A média do tamanho da ferida operatória foi maior no grupo do adesivo em relação ao grupo da sutura, mas não houve correlação entre o tamanho da ferida e o maior número de deiscências. CONCLUSÃO: o 2-octilcianoacrilato apresentou maior risco de deiscência em relação à sutura intradérmica, com resultados estéticos equivalentes.