FIBRIN SEALING IN PEPTIC-ULCER BLEEDING - THE FATE OF THE CLOT

Background and Study Aims: The injection of fibrin tissue glue is a pr omising endoscopic method for hemostasis of peptic ulcer bleeding. So far, no clinical study has focused on the ulcer healing process after endoscopic fibrin injection. Patients and Methods: A morphological stu dy was performed on all resection specimens from patients operated on between 1 January 1994 and 31 December 1996 for gastroduodenal ulcer b leeding with prior endoscopic injection of fibrin glue. The fibrin clo t was characterized histologically for its size, location and aspect. Results: Of 227 patients endoscopically treated with a double-lumen ne edle, 20 underwent resection, The interval between fibrin injection an d resection ranged from 6 hours to 9 days. In 15 patients the ulcer wa s identified In the resection specimen. No fibrin remnants were detect able in three, sparse fibrin deposits were seen in eight and large amo unts of fibrin were noted in the submucosa or subserosa in four specim ens. With increasing time, the clot was gradually organized by phagocy tes and angio-fibroblasts and was finally replaced by endogenous granu lation tissue. An exuberant or tissue-destructive reaction did not app ear. Conclusions: In this study, endoscopic fibrin sealing of bleeding ulcers resulted in appearance of a bland fibroblast-rich granulation tissue. The depth of fibrin glue injection is difficult to standardize with the aid of double-lumen needles.