Multiple cyanoacrylate (Histoacryl) emboli after injection therapy of cardia varices - 23/08/11
Doi : 10.1016/j.gie.2009.06.013
Helmut Neumann, MD, PhD
Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
Klaus Mönkemüller, MD, PhD, FASGE
Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany, and Department of Gastroenterology, Hepatology and Infectious Diseases, Marienhospital, Bottrop, Germany
Maciej Pech, MD, PhD
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
Peter Malfertheiner, MD, PhD
Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| Commentary As this case shows, bleeding gastric varices are amenable to obliteration with n-butyl-cyanoacrylate (Histoacryl) diluted with lipiodol. Cyanoacrylate adhesives were synthesized in 1949 and were used in the 1950s and 1960s to bond human tissue. Cyanoacrylate is an acrylic resin that rapidly polymerizes in the presence of water, as is found on moist human tissue, joining the bonded surfaces together. Lipiodol is an iodinated radiopaque contrast agent derived from poppy seed oil that does not affect the polymerization of cyanoacrylate. Properties of cyanoacrylates vary dramatically, however, and are significantly influenced by chain length. For example, the rate of biodegradation is inversely proportional to chain length. Therefore, short-chain acrylics degrade faster, producing significant heat and more metabolites, such as formaldehyde and cyanoacetate, which cause histologic damage and impair wound healing. For medical tissue glues, we use long-chain monomers rather than those used for commercial adhesives, because they do not cause tissue damage and are sloughed off before any significant tissue toxicity; also, the longer the side chain, the more flexible the monomer. The tissue adhesives are unique in that they also have antibacterial properties, especially against gram-positive bacteria. Severe glue pulmonary embolism is a rare complication of injection therapy, after the glue sets up and then fractures off. Wilhelm Stekel, the Austrian psychoanalyst, said of candor that it may heal or it may separate. Here, the cyanoacrylate healed (the ulcer) and then separated (and caused the embolization). Indeed, many of the therapies we use in medicine are double-edged swords. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2009
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 70 - N° 5
P. 1025-1026 - novembre 2009 Retour au numéro
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