Transcatheter arterial embolization using N-butyl-2-cyanoacrylate (NBCA) for gastrointestinal bleeding

Gastrointestinal (GI) bleeding is a common and potentially life-threatening emergency that often requires urgent medical intervention. While endoscopic and medical treatments remain the first-line approaches, transcatheter arterial embolization has emerged as a critical alternative for cases refractory to conventional management. Among various embolic materials, N-butyl-2-cyanoacrylate (NBCA) offers notable advantages due to its rapid polymerization, mechanical vessel occlusion independent of the coagulation cascade, and superior penetration into distal and collateral vessels. NBCA embolization demonstrates high technical success rates (96.4%-100%) and clinical success rates (74.5%-91%), with lower rebleeding rates (9.3%) compared to coils (20.8%), especially in coagulopathic patients. This review discusses the mechanism of action, technical considerations, efficacy, clinical outcomes, and potential complications associated with NBCA embolization for GI bleeding. Additionally, it explores evolving techniques and modified NBCA formulations aimed at improving safety and efficacy. With careful patient selection and experienced operator technique, NBCA embolization offers an effective, minimally invasive solution for controlling GI bleeding, particularly in high-risk and coagulopathic patients.