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Jornal Português de Gastrenterologia

versão impressa ISSN 0872-8178

J Port Gastrenterol. v.16 n.3 Lisboa jun. 2009

 

O Cianoacrilato na Terapêutica Endoscópica de Úlceras Pépticas em Doentes de Alto Risco: a propósito de 8 casos.

 

P. Peixoto1, P. Ministro1, A. Sadio1, A. Castanheira1, E. Cancela1, A. Silva1, A. Caldas1

 

 

RESUMO

Introdução/Objectivos: A úlcera péptica sangrante é a principal causa de hemorragia digestiva alta. São vários os métodos hemostáticos endoscópicos disponíveis com eficácias similares. O cianoacrilato, utilizado na hemorragia varicosa com sucesso, é ainda controverso na hemorragia de etiologia péptica. Os autores apresentam uma casuística com a utilização de cianoacrilato, em doentes de alto risco cirúrgico, com úlcera hemorrágica refractária à hemostase endoscópica convencional.

Material/Métodos: Estudo retrospectivo baseado na análise de processos clínicos de 8 doentes (7 homens, idade média de 78 anos), entre Janeiro/2004-Julho/2006. Medidas de evolução desfavorável: persistência/recidiva hemorrágicas e mortalidade. Foram analisadas as complicações associadas à terapêutica.

Resultados: Localização das úlceras: 2 gástricas, 5 duodenais e 1 úlcera com componente gastro-duodenal; estigmas endoscópicos (Forrest): 2 IA, 1 IB e 5 IIA. Utilização de cianoacrilato em 3 (37,5%) doentes por persistência hemorrágica e em 5 (62,5%) por recidiva. A hemostase foi bem sucedida em todos os doentes. Não houve recidivas. Ocorreram duas complicações embólicas. A mortalidade foi de 12,5% (1 doente).

Conclusões: O cianoacrilato mostrou ser um método hemostático eficaz no tratamento da úlcera péptica sangrante, contudo com potencial de causar complicações graves; pode ser uma alternativa à falência das técnicas endoscópicas convencionais, em doentes com elevado risco cirúrgico.

 

 

SUMMARY

Background/Study aims: Bleeding peptic ulcer is still the main cause of upper gastrointestinal haemorrhage. Several endoscopic haemostatic methods with similar efficacy are currently available. Cyanoacrylate is successfully used in variceal haemorrhage, however, its use is controversial in bleeding peptic ulcer. The authors present a study with endoscopic injection of cyanoacrylate for the treatment of haemorrhagic ulcers refractory to conventional endoscopic haemostasis in surgical high-risk patients.

Patients and methods: Retrospective study based on the analysis of medical records of 8 patients (7 men, mean age 78 years), between January/2004-July/2006. End points: ongoing haemorrhage, rebleeding and mortality. Complications caused by endoscopic treatment were analised.

Results: Ulcers location: 2 gastric, 5 duodenal, and 1 extensive ulcer with gastro-duodenal component; endoscopic stigmata (Forrest): 2 IA, 1 IB and 5 IIA. Cyanoacrylate was used in 3 (37.5%) patients due to ongoing bleeding and in 5 (62.5%) due to rebleeding. Haemostasis was successful in all patients. No rebleeding occurred. There were two embolic complications. The mortality rate was 12.5% (1 patient).

Conclusions: Cyanoacrylate proved to be an effective haemostatic method for the treatment of bleeding peptic ulcer, although it has the potential to cause serious complications. It may be an alternative after failure of conventional endoscopic techniques in surgical high-risk patients.

 

 

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1Serviço de Gastrenterologia – Hospital de São Teotónio – Viseu

Correspondência:

Paula Cristina Pereira Peixoto

Hospital S. Teotónio

Avenida Rei D. Duarte, 3504-509 Viseu

Telefone: 232 420500

Fax: 232 420591

Email: paulacristinapeixoto@iol.pt

Recebido para publicação: 04/04/2008

Aceite para publicação: 24/02/2009