Arterial Embolisation in Management of Massive Bleeding from Gastric and Duodenal Ulcers

Ljungdahl, Mikael; Eriksson, Lars-Gunnar; Nyman, Rickard; Gustavsson, Sven

doi:10.1080/110241502320789050

Cited by 62 publications

(34 citation statements)

References 14 publications

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“…At this point, surgery is offered to low-risk patients and percutaneous embolotherapy to high-risk patients. Finally, endovascular treatment can be used if the bleeding recurs after surgery [19] .…”

Section: Indicationsmentioning

confidence: 99%

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Loffroy¹,

Guiu²

2009

WJG

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Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients, endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduodenal ulcers after failed endoscopic hemostasis. Here, we present an overview of indications, techniques, and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment, can be performed with high technical and clinical success rates, and should be considered the salvage treatment of choice in patients at high surgical risk.

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Section: Indicationsmentioning

confidence: 99%

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Loffroy¹,

Guiu²

2009

WJG

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“…Very few embolizations have been conducted with this indication in our series. Most of our upper hemorrhages were related to varicose bleeding without extravasation at arteriography and the results of Ljungdal et al [24] (embolization and permanent hemostasis achieved in all but one patient who had ulcerative gastric or duodenal disease) are not applicable to our group. In another study [25], arterial embolization for upper gastrointestinal bleeding was effective in 99%, with a periprocedural mortality rate of 35%.…”

Section: Discussionmentioning

confidence: 38%

Treatment of gastrointestinal hemorrhage

et al. 2005

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Background: We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage. Methods: We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome. Results: Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization. Conclusion: Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instances.

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“…High technical and clinical success rates of endovascular treatments for GI bleeding have been reported [7][8][9][10][11][12]. TAE is generally regarded as a safe procedure with few complications.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

Moriya

Kakeda

Watanabe

et al. 2017

Interventional Radiology

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A 60-year-old man with a history of rheumatoid arthritis experienced bloody stool and presented in a state of shock. Emergency endoscopy showed upper gastrointestinal bleeding from a duodenal ulcer. Endoscopic hemostasis was attempted but failed. Gastroduodenal angiography revealed an extravasation from a duodenal branch of the anterior superior pancreaticoduodenal artery (ASPDA). Hemostasis was achieved by subsequent selective transarterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) performed via the duodenal branch. Although no recurrent bleeding was observed, walled-off necrosis (WON) developed twice at 1 and 8 months after TAE due to localized necrotizing pancreatitis. WON is a rare but potentially serious complication of TAE with NBCA from a branch of the ASPDA.

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Arterial Embolisation in Management of Massive Bleeding from Gastric and Duodenal Ulcers

Abstract: Angiographic embolisation may be an effective way to stop massive bleeding from gastroduodenal ulcers. Emergency operations in poor surgical candidates can therefore be avoided.

Cited by 62 publications

References 14 publications

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Treatment of gastrointestinal hemorrhage

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

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