Background

Gastric bypass is an effective treatment for prolonged weight-loss and carries a 4% incidence of postoperative esophagitis/esophageal ulcer. This seven-patient retrospective case series describes the use of fibrin sealant as a primary treatment for esophageal ulcers. Seven female patients, 50±9 years-of-age (Mean±SD), with a mean body mass index of 32.3±6.4, who underwent gastric bypass 7.0±4.9 years prior, reported symptoms consistent with an esophageal ulcer (Table 1). On esophagogastroduodenoscopy (EGD), 3 patients had a single esophageal ulcer <5mm, 2 with a single ulcer >10mm and 1 with multiple-sized ulcers. Four ml of fibrin sealant, Tisseel (Baxter), was applied to the ulcer using a 180-cm catheter applicator, Duplocath 180 (Baxter) (Figure 1A, 1B). Fibrin sealant was applied uniformly over the ulcer and allowed to polymerize for 2 minutes (Figure 1C, 1D). Pain resolved in 71% of patients (5 of 7) at 24 hours after treatment. Pain resolved completely in 86% of patients (6 of 7), on average, 5.5±1.3 months after treatment. The patient without resolved pain, underwent esophageal resection despite no ulcer being visible on EGD. Tisseel is indicated as an adjunctive hemostatic agent and as a surgical sealant. Tisseel contains aprotinin, an antifibrinolytic. Fibrin sealant clots containing aprotinin may slow clot degradation to provide a protective effect in the acidic environment aboral of the esophageal sphincter. Fibrin sealant has been shown to have wound healing properties that may promote the healing of esophageal tissue. Given 71% immediate and 86% long-term resolution, Tisseel may be an effective treatment option for esophageal ulcers.