Recurrent Bacteremia, a Complication of Cyanoacrylate Injection for Variceal Bleeding: Report of Two Cases and Review of the Literature

Galpérine, Tatiana; Flateau, C.; Venon, M. D.; Lescure, F.-X.; Béraud, Guillaume; Ibrahim, T. Said; Delisle, F.; Durand, F.; Faure, Kim; Pialoux, Gilles; Guery, Benoît

doi:10.1155/2009/407053

Cited by 7 publications

(10 citation statements)

References 10 publications

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“…Most recurrent episodes of bacteremia were caused by the same microorganism [ 2 , 4 , 6 ], except for the present report and one other [ 14 ], in which multiple bacteria were implicated. All the microorganisms isolated from blood cultures in all reports were commensals from the oral or gastrointestinal flora.…”

Section: Discussionmentioning

confidence: 70%

“…In six of the reported cases including this one, complications associated with cyanoacrylate, such as abscess [ 4 ] or embolism [ 4 , 6 ], were found. Two cases of persistent (but not recurrent) bacteremia reported showed incomplete obliteration of gastric varices, possibly facilitating bacterial translocation.…”

Section: Discussionmentioning

confidence: 99%

“…Besides the present case, six other cases of recurrent bacteremia following variceal sclerosis with N -butyl-2-cyanoacrylate were reported in the English language literature. The characteristics of the seven cases are shown in Table 1 [ 2 , 4 , 6 , 14 ]. All patients had portal hypertension and the indication of injection of cyanoacrylate was bleeding from gastric varices.…”

Section: Literature Reviewmentioning

confidence: 99%

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Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature

et al. 2015

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BackgroundBleeding from gastric varices has high mortality rate, and obliteration using N-butyl-2-cyanoacrylate is the treatment of choice. Recurrent bacteremia is rarely reported following the procedure. We aimed to report a case of recurrent bacteremia after N-butyl-2-cyanoacrylate treatment and to review published cases.Case presentation and reviewIn May 2014, a 43-year-old Brazilian male presented with lower gastrointestinal bleeding. Endoscopy showed active bleeding from gastric varix. Injection of N-butyl-2-cyanoacrylate was performed and the patient was discharged. Over the next 4 months he presented with three episodes of bacteremia with severe sepsis and no identifiable focus of infection. Oral prophylaxis was initiated in September 2014 and he has remained free of bacteremia. Six other cases of recurrent bacteremia following sclerosis with N-butyl-2-cyanoacrylate were reported in the literature. All patients had portal hypertension and bleeding from gastric varices. Average age of patients was 55.7 years and the median time from endoscopic procedure to the first episode of bacteremia was 105 days (range 14–365). The mean number of episodes of bacteremia per patient was 2.5.ConclusionRecurrent bacteremia associated with endoscopic treatment with N-2-butyl-cyanoacrylate is rare, but should be suspected in patients in which investigation shows no other focus of infection. Secondary prophylaxis should be considered after the first episode.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature

et al. 2015

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“…According to the latest literature, cyanoacrylate closure offers success rates equivalent to endovenous thermal ablation with lower rates of complications [4,5]. However, although complications are rare, cyanoacrylate glue treatment can potentially lead to issues such as phlebitis, cellulitis, and deep vein thrombosis, with bacteremia and hypersensitivity reactions also having been reported [6][7][8][9][10][11]. We report the case of an 86-year-old woman who developed a persistent iliac vein thrombosis after CAC of the great saphenous vein.…”

Section: Dear Editorsmentioning

confidence: 99%

Persistent iliac vein thrombosis after cyanoacrylate closure of the great saphenous vein

Gressenberger

Portugaller

Gütl

et al. 2020

J Deutsche Derma Gesell

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“…75 A few reports have described recurrent bacteremia from an infected glue conglomerate in the GV this has been successfully treated with repeated courses of antibiotics. 76,77 A recent report described GVO complicated by pyogenic spleno-portal thrombosis which led to persistent Klebsiella pneumoniae septicemia. The glue plug is a foreign body that offers an ideal surface for bacterial colonization and becomes a reservoir for continuous bacterial dissemination.…”

Section: Journal Of Clinical and Experimental Hepatologymentioning

confidence: 99%

Gluing Gastric Varices in 2012: Lessons Learnt Over 25 Years

Saraswat¹,

Verma²

2012

Journal of Clinical and Experimental Hepatology

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Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consensus has been reached on the best way for treating these patients. Gastric variceal obturation (GVO) with the tissue adhesive, N-2-butyl-cyanoacrylate (NBC), is considered the treatment of first-choice for this condition in most parts of the world. The liquid monomer polymerizes into a solid cast, obturating the vessel within 10-20 s of coming in contact with ionic solutions such as blood. Gastric variceal obturation achieves hemostasis in over 90% of patients with active bleeding, eradicates GV in over 80% of these patients, and re-bleeding occurs in 3-30%. These results are comparable with those of transjugular intrahepatic portosystemic shunting (TIPS; over 90% hemostasis in acute bleeding with re-bleeding in 15-30%). Though, there has been no direct comparison with GVO, balloon-occluded retrograde transvenous obliteration of GV (BRTO) achieves near 100% obliteration with recurrence in 0-10% and is superior to TIPS for hemostasis in active bleeding when used in combination with transcatheter sclerotherapy. Several complications have been described for GVO including thromboembolic complications which occur in 0.5-4.3% and may be devastating in some. Many of the complications and the variability in results of GVO can be attributed to variations in injection technique. The use of a standardized injection technique has been reported to achieve 100% hemostasis and obliteration with 6.9% re-bleeding and no embolic complications. Gastric variceal obturation with NBC continues to be the first-choice therapy for GV bleeding outside Japan. Adherence to a standard injection technique will maximize hemostasis and eradication of GV while minimizing complications of therapy.

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Recurrent Bacteremia, a Complication of Cyanoacrylate Injection for Variceal Bleeding: Report of Two Cases and Review of the Literature

Cited by 7 publications

References 10 publications

Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature

Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature

Persistent iliac vein thrombosis after cyanoacrylate closure of the great saphenous vein

Gluing Gastric Varices in 2012: Lessons Learnt Over 25 Years

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