Endoscopic use of fibrin adhesives

Abstract

When used endoscopically fibrin adhesives are injected through twin-lumen catheters, which can reach up to 180 cm in length. Because fibrinogen solutions have a high viscosity, significant delivery forces are necessary, resulting in discomfort for the operator. Therefore, the two predominant fibrin sealants were characterized with respect to their viscosity and the force needed for their injection. Viscosity was determined at 18 degrees C, 25 degrees C, and 37 degrees C in a micro-Ostwald viscosimeter. Additionally, the maximum forces needed for injection through a 27-cm and a 160-cm catheter were determined at 25 degrees C in an Instron materials testing machine. Compared with preparation A the viscosity of preparation B was 8.0-34.5 times higher at 18 degrees C, 4.6-13.8 times higher at 25 degrees C and 3.1-6.4 times higher at 37 degrees C. In consequence, the delivery forces were 1.5-2.5 times (27 cm probe) and 3.4-4.5 times (160 cm probe) the values determined for preparation A. For preparation B a maximum load of 3.8 kg was necessary for injection. Assuming that different adhesive preparations have the same effect, a preparation of lower viscosity seems to be more suitable for use via long catheters than a preparation of high viscosity.

Hepatocellular carcinoma: preclinical data on a dual-lumen catheter kit for fibrin sealant infusion following loco-regional treatments

“…Despite considerable progress in the treatment of HCC in situ procedures for the treatment of unresectable hepatic malignancies are associated with serious complications, including abdominal haemorrhage and bile leakage [ 11 , 12 , 15 , 20 – 30 ]. Fibrin sealants have been used successfully in a variety of surgical and endoscopic settings to promote haemostasis and tissue sealing [ 18 , 19 , 25 , 31 ]. Even if a perfect hepatic resection has been carried out postoperative bleeding and segregation of fluids can occur though the resection.…”

“…They are normally applied to the resected area using dual-chamber delivery systems, with one chamber containing fibrinogen and the other thrombin. Application of fibrin sealants in open surgery is relatively straight-forward [ 17 ], but delivery through an injection catheter in endoscopic procedures is more problematic as considerable force may be required to inject the highly viscous fibrinogen component through a long catheter [ 14 , 18 , 19 ]. In addition, because the two sealant components have different viscosities and consequently diverse flow rates through the catheter, inappropriate clot formation at the distal end of the catheter and clogging can occur.…”

Injectable Thermosensitive Chitosan Solution with β-Glycerophosphate as an Optimal Submucosal Fluid Cushion for Endoscopic Submucosal Dissection

“…A HA-based product, the Blue Eye™ submucosal injection agent by The Standard Co., Ltd. in Republic of Korea, is CE approved. However, generally, if a solution has a high viscosity, it requires high injection force by endoscopists to inject the solution, complicating the procedure and reducing the success rate [ 9 ]. Recently, another submucosal injection agent was commercially developed by Boston Scientific, the composition of which is unknown [ 10 ].…”