Fibrin sealants are used in a wide range of surgical procedures, its primary function is a haemostatic agent, but also assists tissue sealing and wound healing [1]. Tisseel (Immuno, Toronto, Ontario, Canada) is a fibrin sealant that works through the formation of a fibrin gel, by combining fibrinogen and other plasma proteins with thrombin under controlled conditions.Endoscopic placement of fibrin sealant has proved successful in the treatment of oesophageal leaks, perforations and fistulas [2]. Tissue sealant has been used successfully in a case of persistent...

We present four cases of oesophageal leaks/perforations treated by injection of fibrin-glue sealant and covered stent.The patient is positioned in a left lateral position and is sedated.A 5F KMP catheter with a short angled tip is passed per oral and the site of leak is identified with injection of non-ionic contrast.Under flouroscopic control, theneck of the leak is entered with hydrophilic coated wire with catheter guidance (75 cm 5F KMP, Cook, Bloomington, Ind). The catheter is advanced over the wire through the neck. On slow...

Following fibrin-glue injection, 3 of 4 four cases showed complete occlusion of track, with no contrast passing through the leak on subsequent contrast study. One patient who had a > 2cm neck to the leak required two treatments using the same method before the leak was successfully treated.All four patients were re-commenced on oral feeds and made a good recovery and the stents were removed between 6 and 8 weeks.From our work several technical issues have arisen.The double lumen catheter which is used to keep...

Our experience suggests oesophageal leaks/perforations may be sealed fluoroscopically without endoscopy or surgical thoracotomy using tissue sealant and stenting. The technique shows promise though there are technical challenges as the kit is designed to allow delivery of the sealant through an endoscope under direct vision. Also, a larger study would be required to demonstrate a significant additional benefit from stenting alone.

[1] Albala DM.Fibrin sealants in clinical practice. Cardiovascular Surg. 2003 Aug;11 Suppl 1:5-11.[2]. Truong S, Böhm G, Klinge U, et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc. 2004 Jul;18(7):1105-8. 2004 May 27.[3] Harries K, Masoud A, Brown TH, Richards DG. Endoscopic placement of fibrin sealant as a treatment for a long-standing Boerhaave's fistula. Dis Esophagus. 2004;17(4):348-50[4] Brady AP, Malone DE, Tam P, McGrath FP. Closure of a duodenal Fistula with fibrin...

Andy SwiftRadiology SpR Hull and East Yorkshire Hospitals NHS [email protected]@gmail.com