Endovascular management of nonvariceal upper gastrointestinal hemorrhage

Abstract

Upper gastrointestinal bleeding (UGIB) remains a frequent presentation in the emergency department. There are several causes of UGIB, which can be generally classified into variceal and nonvariceal bleeding. Although most cases of nonvariceal UGIB spontaneously resolve or respond to medical management and/or endoscopic treatment, transcatheter arterial embolization (TAE) remains an important available tool in the emergency evaluation and management of nonvariceal UGIB. In this article, we will discuss the current strategies for rendering a specific diagnosis of nonvariceal UGIB, and we will focus on the various TAE techniques for its management. We will also provide an algorithm for the diagnostic work-up of these patients. The majority of patients with nonvariceal UGIB that is refractory to endoscopic treatment is successfully treated with minimally invasive TAE and can avoid undergoing surgery.

Transcatheter Arterial Embolisation of Acute Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Haemostasis

“…It therefore must have an internal diameter that allows introduction of the chosen embolic agent. 3,7 Embolisation can be classified as localised, proximal, or segmental. 21 In localised embolisation, superselective embolisation at the site of bleeding is performed without embolising other non-target arteries (Figure 3).…”

“…This distinction is important, as localisation of the bleeding source determines the therapeutic approach. [1][2][3] The most common cause of nonvariceal UGIB is peptic ulcer disease. Other less common causes include benign and malignant tumours, ischaemia, gastritis, Mallory-Weiss tears, trauma, iatrogenic factors, and arteriovenous malformations such as Dieulafoy's lesions.…”

“…6 However, endoscopic evaluation and potential treatment are sometimes not technically feasible because of oesophageal strictures, altered anatomy from prior surgery, or profuse bleeding. 3 Of the small group of patients whose bleeding fails to respond to endoscopic therapy, some are treated surgically, but the majority have been increasingly referred for transcatheter arterial embolisation (TAE). 6 Surgical treatment is typically reserved for patients whose bleeding has failed to respond to all previous treatments.…”

“…6 The development of newer catheter techniques and embolic devices over the last three decades has made percutaneous TAE the standard management technique for UGIB in patients with unfeasible or failed endoscopic management of bleeding. 3,6 The purpose of this review is to summarise the data on the aetiologies, indications, techniques, and outcomes of TAE for acute nonvariceal UGIB.…”

Embolization of Nonvariceal Upper Gastrointestinal Hemorrhage Complicated by Bowel Ischemia

“…[20][21][22] Bleeding into the gastrointestinal tract can be detected with visceral angiography at rates as low as 0.5 mL/min. 23 Marking the site of bleeding with metallic clips during endoscopy has been shown to aid in the accurate localization of a bleeding source. 24 There are limitations of angiography that can result in false-negative studies.…”