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2-Octyl Cyanoacrylate

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Christopher J. Gostout – One of the best experts on this subject based on the ideXlab platform.

  • Sa1566 Efficacy and Safety of 2-OctylCyanoacrylate Injection for the Treatment of Gastric Variceal Hemorrhage
    Gastrointestinal Endoscopy, 2011
    Co-Authors: Atif Saleem, Navtej S. Buttar, Elizabeth Rajan, Christopher J. Gostout, Todd H. Baron, Louis-michel Wong Kee Song
    Abstract:

    Efficacy and Safety of 2-OctylCyanoacrylate Injection for the Treatment of Gastric Variceal Hemorrhage Atif Saleem, Navtej Buttar, Elizabeth Rajan, Christopher J. Gostout, Todd H. Baron, Louis-Michel Wong Kee Song Mayo Clinic, Rochester, MN Background: Endoscopic injection of Cyanoacrylate (glue) is effective for the treatment of gastric variceal hemorrhage (GVH). Although n-butyl-2 Cyanoacrylate (Histoacryl®) is the most commonly used agent worldwide, it is not readily available in the U.S. As an alternative, our group has utilized 2-Octyl Cyanoacrylate (Dermabond®), an FDA-approved agent for wound closure. The off-label, intravariceal injection of 2-Octyl Cyanoacrylate (OCA) for GVH has been a treatment option at our institution since 2000. Aim: To assess the efficacy and safety of OCA injection for the treatment of GVH. Methods: The medical records of patients treated with OCA injection for GVH from 1/2000 to 7/2010 were reviewed retrospectively. Data were extracted for patient demographics, type of gastric varices (GV) according to Sarin classification, bleeding stigmata, OCA dose and number of sites injected per treatment session, initial hemostasis and rebleeding rates, procedure-related complications, and mortality. Undiluted OCA was injected at a rate of 1 ml/15 sec until bleeding cessation and/or hardening of the varix. Repeat endoscopy was performed at 4 wks to assess for variceal obliteration and treatment of any residual GV. Follow-up endoscopy was performed at 6-12 months thereafter. Results: A total of 62 patients (40 men) were identified. Cirrhotic portal hypertension was the cause of GV in 70% of cases. GV were classified as GOV1 in 2%, GOV2 in 63% and IGV1 in 35% of cases. Active bleeding, stigmata of recent bleeding (e.g., fibrin plug) and presumed bleeding from large GV were noted in 24%, 53% and 23% of patients, respectively. The mean volume of OCA injected was 6.5 ml (range 2-16 ml) with a mean of 2 injection sites (range 1-6) per treatment session. In patients with actively bleeding GV (n 15), immediate hemostasis was achieved in 93% of cases following OCA injection. The overall rebleeding rate was 6%. In 2 patients, early ( 1 wk) recurrent massive GVH required rescue TIPS which failed to control bleeding in one patient who subsequently died. Late ( 1 wk) recurrent GVH occurred in 2 patients; one patient was successfully retreated with OCA injection and the other patient opted for comfort care in the setting of multiorgan failure. Glue-related pulmonary embolism occurred in 2 (3%) patients, which was fatal in one. The mean (SD) follow-up was 17 (15) months. Bleeding-related mortality was 6% and the overall mortality was 23%. Conclusions: Endoscopic injection of 2-Octyl Cyanoacrylate is a relatively safe and effective endoscopic treatment option for gastric variceal hemorrhage. The outcomes are comparable to those reported for endoscopic variceal injection using n-butyl-2 Cyanoacrylate.

  • Pulmonary Embolization of 2-Octyl Cyanoacrylate After Endoscopic Injection Therapy for Gastric Variceal Bleeding
    Mayo Clinic proceedings, 2004
    Co-Authors: Otis B. Rickman, James P. Utz, Gregory L. Aughenbaugh, Christopher J. Gostout
    Abstract:

    N-butyl-2-Cyanoacrylate, a tissue adhesive that polymerizes on contact with weak bases such as blood, is being used widely outside the United States to obliterate gastric varices. Embolization of this material can occur via portosystemic shunts. We report a case of pulmonary embolization of 2-Octyl Cyanoacrylate (an analogue of N-butyl-2-Cyanoacrylate) that occurred after endoscopic injection therapy for gastric variceal bleeding. Cyanoacrylate embolism is difficult to diagnose with computed tomographic angiography because radiopaque emboli are masked by the contrast material. It is important to distinguish these emboli from conventional thromboemboli because “glue emboli” require only symptomatic treatment. Clinicians should have a high index of suspicion for embolism in the setting of tachycardia, chest pain, or hypoxia after a patient undergoes endoscopic injection therapy with Cyanoacrylate glue for gastric variceal bleeding. The radiologist should be alerted so that the appropriate radiographic settings are used to make the diagnosis.

  • 2 octyl Cyanoacrylate dermabond a new glue for variceal injection therapy results of a preliminary animal study
    Gastrointestinal Endoscopy, 2002
    Co-Authors: Adrienne J Nguyen, Elizabeth Rajan, Todd H. Baron, Lawrence J Burgart, Olga Leontovich, Christopher J. Gostout
    Abstract:

    Background: Endotherapy of bleeding gastric varices is problematic. The aim of this descriptive study in an animal model was to compare 2-OctylCyanoacrylate (Dermabond), a Food and Drug Administration-approved agent for superficial wound closure, to N-butyl-2-Cyanoacrylate (Histoacryl), an agent available outside of the United States for the endoscopic treatment of bleeding gastric varices. Methods: Eight New Zealand white rabbits were randomly assigned to either the study agent Dermabond or the control agent, Histoacryl. Both active agents were equally mixed with ethiodized poppy seed oil (Ethiodol) and injected into the auricular vein. The animals were euthanized at various time intervals after injection. A 2 cm strip of tissue on either side of the injection site along with the adjacent perivascular tissues were resected for histologic evaluation. Results: The use of 0.5 mL of Dermabond effectively induced vascular occlocclusion compared with 0.2 mL of Histoacryl. The histologic changes acutely and at 1 week were similar with each mixture. Conclusion: Dermabond may be useful in the treatment of gastric variceal bleeding, but further studies are necessary to determine dose response rates in animals and humans.

Zun Chang Liu – One of the best experts on this subject based on the ideXlab platform.

  • A modified percutaneous transhepatic varices embolization with 2-Octyl Cyanoacrylate in the treatment of bleeding esophageal varices.
    Journal of clinical gastroenterology, 2009
    Co-Authors: Chunqing Zhang, Fu Li Liu, Bo Liang, Kai Feng, Zun Chang Liu
    Abstract:

    Background: To evaluate the effect of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-Octyl Cyanoacrylate (2-OCA) on the prevention and treatment of esophageal variceal bleeding. Methods: Between March 2002 and December 2005, PTVE was attempted in 92 patients with esophageal varivarices, 74 patients with recent variceal bleeding, 18 patients with acute variceal bleeding. The 2-OCA was injected into the entire lower esophageal and periesophageal or paraesophageal varices, the cardial submucosal, and perforating vessels. Results: PTVE was successfully performed in 89 of 92 patients, providing a procedural success rate of 96.7%. According to the distribution of injected 2-OCA, 3 types of variceal embolization were defined, esophagogastric obliteration (n = 42), gastric obliteration (n = 34), and main left gastric vein obliteration (n = 13). Acute variceal bleeding was immediately arrested in all 18 (100%) patients after the procedure. During the median follow-up period of 37 months, the total rebleeding rate was 19.1% (17/89), with the rate being higher in patients with main left gastric vein obliteration 46.1% (6/13) than in patients with esophagogastric obliteration 9.5% (4/42) or with gastric obliteration 20.6% (7/34, P < 0.05). Total survival rate was 74.4%, with the rate being significantly higher in patients with esophagogastric obliteration and gastric obliteration than that in patients with left gastric vein obliteration demonstrated by Kaplan-Meier analysis (P < 0.001, log-rank test). There was 1 patient with fatal bleeding at the puncture site after the PTVE procedure, and 1 patient with slight pulmonary embolism; there were no other major procedure-related complications. Conclusions: The effect of PTVE with 2-OCA on esophageal varivarices is associated with the site and range of embolization. With the lower esophageal and periesophageal varices and/or the cardial submucosal and perforating vessels are sufficiently obliterated, PTVE with 2-OCA can improve long-term efficacy by preventing varices recurrence and rebleeding.

  • A Modified Percutaneous Transhepatic Variceal Embolization with 2-Octyl Cyanoacrylate Versus Endoscopic Ligation in Esophageal Variceal Bleeding Management: Randomized Controlled Trial
    Digestive diseases and sciences, 2007
    Co-Authors: Chunqing Zhang, Fu Li Liu, Bo Liang, Kai Feng, Zi Qin Sun, Zun Chang Liu
    Abstract:

    Background Conventional percutaneous transhepatic varices embolization (PTVE) has rarely been used in recent years due to high rates of variceal recurrence and rebleeding. Herein we report a modified PTVE with 2-Octyl Cyanoacrylate (2-OCA) in which the whole lower esophageal and peri or para-esophageal varivarices, the submucosal varices, and the advertitial plexus of the cardia and fundus were sufficiently obliterated. We compared this PTVE with endoscopic band ligation (EVL) in the treatment of esophageal variceal bleeding. Methods In this prospective randomized controlled trial, cirrhotic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE (52 patients) or EVL (50 patients) groups. Upper gastrointestinal (UGI) rebleeding, esophageal variceal rebleeding, and survival were followed-up. Computerized tomography (CT) scanning and portal venography were used to observe 2-OCA distribution. Results During the follow-up period (median 24 and 25 months in the PTVE and EVL groups, respectively) UGI rebleeding developed in eight patients in the PTVE group and 21 patients in EVL group (P = 0.004). Recurrent bleeding from esophageal varivarices occurred in three patients in the PTVE group and twelve in the EVL group (P = 0.012, relative risk 0.24, 95% confidence interval 0.05–0.74). Multivariate Cox analysis indicated that the treatment was the only factor predictive of rebleeding. A Kaplan–Meier curve showed there was no significant difference between survival in the two groups (P = 0.054). Conclusions With the whole lower esophageal and peri or para-esophageal varivarices, the submucosal varices, and the adventitial plexus of the cardia and fundus sufficiently obliterated by 2-OCA, this modified PTVE was more effective than EVL in the management of esophageal varivarices recurrence and rebleeding. Survival in these two groups was not significantly different, however.

Chunqing Zhang – One of the best experts on this subject based on the ideXlab platform.

  • Balloon-Assisted Percutaneous Transhepatic Antegrade Embolization with 2-Octyl Cyanoacrylate for the Treatment of Isolated Gastric Varices with Large Gastrorenal Shunts
    Hindawi Limited, 2019
    Co-Authors: Guangchuan Wang, Dongxiao Meng, Guangjun Huang, Qingshan Pei, Lianhui Zhao, Yongjun Shi, Mingyan Zhang, Hua Feng, Junyong Zhang, Chunqing Zhang
    Abstract:

    Aims. To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-Octyl Cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods. Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varivarices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results. PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varivarices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion. Balloon-assisted PTAE with 2-Octyl Cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS

  • A modified percutaneous transhepatic varices embolization with 2-Octyl Cyanoacrylate in the treatment of bleeding esophageal varices.
    Journal of clinical gastroenterology, 2009
    Co-Authors: Chunqing Zhang, Fu Li Liu, Bo Liang, Kai Feng, Zun Chang Liu
    Abstract:

    Background: To evaluate the effect of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-Octyl Cyanoacrylate (2-OCA) on the prevention and treatment of esophageal variceal bleeding. Methods: Between March 2002 and December 2005, PTVE was attempted in 92 patients with esophageal varices, 74 patients with recent variceal bleeding, 18 patients with acute variceal bleeding. The 2-OCA was injected into the entire lower esophageal and periesophageal or paraesophageal varices, the cardial submucosal, and perforating vessels. Results: PTVE was successfully performed in 89 of 92 patients, providing a procedural success rate of 96.7%. According to the distribution of injected 2-OCA, 3 types of variceal embolization were defined, esophagogastric obliteration (n = 42), gastric obliteration (n = 34), and main left gastric vein obliteration (n = 13). Acute variceal bleeding was immediately arrested in all 18 (100%) patients after the procedure. During the median follow-up period of 37 months, the total rebleeding rate was 19.1% (17/89), with the rate being higher in patients with main left gastric vein obliteration 46.1% (6/13) than in patients with esophagogastric obliteration 9.5% (4/42) or with gastric obliteration 20.6% (7/34, P < 0.05). Total survival rate was 74.4%, with the rate being significantly higher in patients with esophagogastric obliteration and gastric obliteration than that in patients with left gastric vein obliteration demonstrated by Kaplan-Meier analysis (P < 0.001, log-rank test). There was 1 patient with fatal bleeding at the puncture site after the PTVE procedure, and 1 patient with slight pulmonary embolism; there were no other major procedure-related complications. Conclusions: The effect of PTVE with 2-OCA on esophageal varices is associated with the site and range of embolization. With the lower esophageal and periesophageal varices and/or the cardial submucosal and perforating vessels are sufficiently obliterated, PTVE with 2-OCA can improve long-term efficacy by preventing varices recurrence and rebleeding.

  • A Modified Percutaneous Transhepatic Variceal Embolization with 2-Octyl Cyanoacrylate Versus Endoscopic Ligation in Esophageal Variceal Bleeding Management: Randomized Controlled Trial
    Digestive diseases and sciences, 2007
    Co-Authors: Chunqing Zhang, Fu Li Liu, Bo Liang, Kai Feng, Zi Qin Sun, Zun Chang Liu
    Abstract:

    Background Conventional percutaneous transhepatic varices embolization (PTVE) has rarely been used in recent years due to high rates of variceal recurrence and rebleeding. Herein we report a modified PTVE with 2-Octyl Cyanoacrylate (2-OCA) in which the whole lower esophageal and peri or para-esophageal varices, the submucosal varices, and the advertitial plexus of the cardia and fundus were sufficiently obliterated. We compared this PTVE with endoscopic band ligation (EVL) in the treatment of esophageal variceal bleeding. Methods In this prospective randomized controlled trial, cirrhotic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE (52 patients) or EVL (50 patients) groups. Upper gastrointestinal (UGI) rebleeding, esophageal variceal rebleeding, and survival were followed-up. Computerized tomography (CT) scanning and portal venography were used to observe 2-OCA distribution. Results During the follow-up period (median 24 and 25 months in the PTVE and EVL groups, respectively) UGI rebleeding developed in eight patients in the PTVE group and 21 patients in EVL group (P = 0.004). Recurrent bleeding from esophageal varices occurred in three patients in the PTVE group and twelve in the EVL group (P = 0.012, relative risk 0.24, 95% confidence interval 0.05–0.74). Multivariate Cox analysis indicated that the treatment was the only factor predictive of rebleeding. A Kaplan–Meier curve showed there was no significant difference between survival in the two groups (P = 0.054). Conclusions With the whole lower esophageal and peri or para-esophageal varices, the submucosal varices, and the adventitial plexus of the cardia and fundus sufficiently obliterated by 2-OCA, this modified PTVE was more effective than EVL in the management of esophageal varices recurrence and rebleeding. Survival in these two groups was not significantly different, however.

Michael A. Mont – One of the best experts on this subject based on the ideXlab platform.

Andrew J. Kirsch – One of the best experts on this subject based on the ideXlab platform.

  • Sutureless and scalpel-free circumcision–more rapid, less expensive and better?
    The Journal of urology, 2010
    Co-Authors: Jonathan D Kaye, James M. Elmore, Jonathan F Kalisvaart, Scott P Cuda, Wolfgang H Cerwinka, Andrew J. Kirsch
    Abstract:

    We previously reported our success with sutureless circumcision using 2-Octyl Cyanoacrylate in 267 patients. We have since modified our technique by making incisions with electrocautery. We report our results with this novel technique. We also performed a cost analysis. We compiled data on all patients 6 months to 12 years old who underwent primary circumcision and circumcision revision in a 39-month period, as done by 3 surgeons. Study exclusion criteria were complexity beyond phimosis and Gomco clamp use. The technique included 1) a circumferential inner incision using electrocautery on cutting current, 2) a circumferential outer incision using electrocautery, 3) foreskin removal, 4) hemostasis with electrocautery, 5) skin edge approximation with 2-Octyl Cyanoacrylate or 6-zero suture and 6) antibiotic ointment application. We also determined the cost of all procedures based on anesthesia and operating room facility fees, and material costs. Between July 1, 2006 and October 1, 2009 we performed 493 primary circumcisions and 248 revisions using 2-Octyl Cyanoacrylate, and 152 primary circumcisions and 115 revisions using 6-zero sutures. Mean operative time for primary circumcision and revision using 2-Octyl Cyanoacrylate was 8 minutes (range 6 to 18), and for sutured primary circumcision and revision it was 27 minutes (range 18 to 48). At a mean 18-month followup (range 1 to 39) 3 patients treated with 2-Octyl Cyanoacrylate and 2 treated with sutures were rehospitalized for bleeding. When done with electrocautery, the cost of the 2-Octyl Cyanoacrylate technique was $743.55 less than the sutured technique as long as the 2-Octyl Cyanoacrylate procedures required less than 15 minutes and the sutured procedures required more than 15 minutes. Combined electrocautery and 2-Octyl Cyanoacrylate for circumcision is a safe, efficient, financially beneficial, cosmetically appealing alternative to traditional circumcision done with scalpel and sutures. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  • Sutureless Circumcision Using 2-Octyl Cyanoacrylate (Dermabond): Appraisal After 18-Month Experience
    Urology, 2007
    Co-Authors: James M. Elmore, Edwin A. Smith, Andrew J. Kirsch
    Abstract:

    Introduction 2-Octyl Cyanoacrylate (2-OCA; Dermabond) is a synthetic tissue adhesive that has proven utility in the closure of minor surgical incisions. Recently, we began using this adhesive for skin closure after circumcision and herein report our experience. Technical Considerations A total of 267 patients (mean age 4 years) underwent circumcision (n = 208) or circumcision revision (n = 59) using 2-OCA for skin closure. The circumcision was performed using a sleeve technique in 219 patients and a Gomco clamp in 48. After meticulous hemostasis, the incision was cleansed, and the skin edges were aligned. Two thin layers of 2-OCA were applied to the incision and allowed to dry. Antibiotic ointment was then applied to the glans and penis. The technique was not used if poor skin edge apposition or bleeding was noted after circumcision. The skin closure time using 2-OCA averaged 3 minutes for the first 150 patients and less than 90 seconds for the last 120 patients, reflecting a learning curve associated with application. At a mean follow-up of 13 months (range 2 to 18), three postoperative complications had occurred. The cosmetic outcomes have been subjectively better than those with standard closure using interrupted 5-0 or 6-0 sutures, with no risk of suture tracks or sinuses. Parental satisfaction has been consistently great. Conclusions Sutureless circumcision closure using 2-OCA is a safe, fast, and cosmetically appealing alternative to standard interrupted suture reapproximation. These advantages have made it our technique of choice. A direct economic and outcome comparison to sutured repairs is ongoing.