Life-threatening intraabdominal arterial embolization after Histoacryl injection for bleeding gastric ulcer

N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of ch oice for acutely bleeding esophagogastric varices, and is the only effectiv e option for endoscopic treatment of gastric varices, Recent reports confir m the ability of Histoacryl injection therapy to achieve immediate hemostas is in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventiona l endoscopic hemostatic treatment had failed. Although the overall safety r ecord of Histoacryl injection has been relatively good, there have been sca ttered cases of serious complications, Here, we present two patients showin g life-threatening intraabdominal arterial embolization after Histoacryl in jection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achi eved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis, Soon after the procedure, intra abdominal arterial embolization developed in both patients. One patient sur vived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, an d we propose that less diluted Histoacryl seems to be preferable in cases o f bleeding peptic ulcers.