Endoscopic Fibrin Glue Injection with Coaxial Double Lumen Needle for Severe Upper Gastrointestinal Bleeding

Although endoscopic hemostasis is an effective treatment for acute upper gastrointestinal bleeding, permanent hemostasis may be difficult to achieve by conventional endoscopic treatment alone in some patients. In addition, conventional hemostatic endoscopic therapy is limited in patients with a risk of gastrointestinal ulcer perforation. We tried endoscopic fibrin glue injection in 21 patients as a new approach to control severe upper gastrointestinal bleeding. A new type of coaxial double lumen needle was used in the last 15 patients. Hemostasis was obtained immediately by fibrin glue injection in all 7 patients after unsuccessful attempts using conventional methods, including absolute alcohol or epinephrine injection, clipping, or electrocoagulation. There were no episodes of rebleeding in this group. In 10 of the 14 patients who underwent endoscopic fibrin glue injection as the primary therapy, complete hemostasis was achieved with the initial treatment. The remaining 4 required a second injection within 48 hours. There were no treatment-related complications. None of the patients required an additional surgical operation for bleeding, and the period of hospitalization was reduced after the introduction of fibrin glue injection. Considering the effect on acceleration of ulcer healing, endoscopic fibrin glue injection is an effective treatment with no risk of tissue injury. This technique can be used as the first choice or after failure of conventional endoscopic hemostatic methods.