Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes

Kuyumcu, Gokhan; Latich, Igor; Hardman, Rulon L.; Fine, Gerald; Öklü, Rahmi; Quencer, Keith

doi:10.3390/jcm7050101

Cited by 11 publications

(8 citation statements)

References 46 publications

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“…Only a few cases of pancreatitis after embolization have been reported in the literature. 18 – 20 In such circumstances, acute pancreatitis may have different clinical presentations. It can present as a prolonged increase in the serum lipase and amylase concentrations with minimal symptomatology, which in most cases resolves spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery as a complication of chronic pancreatitis: a case report

et al. 2022

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A pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. Prompt diagnosis and appropriate treatment are of great clinical importance. We herein present an unusual case of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery that developed as a complication of chronic pancreatitis. It was detected in a timely manner and successfully treated with minimally invasive endovascular therapy.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery as a complication of chronic pancreatitis: a case report

et al. 2022

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“…The technical goal of P-TAE was the embolization of the left gastric artery or gastroduodenal artery (depending on the ulcer localization) within 24 h of endoscopic hemostasis, achieving a decrease of the arterial flow in the tissue beneath the ulcer. In cases with the ulcer localized in the smaller or greater curvature or the gastric fundus, the left gastric artery was obliterated; in cases of gastric antral, pyloric, or duodenal ulcers, the gastroduodenal artery was embolized [8, 12]. Rebleeding was defined as the presence of hematemesis, blood from the nasogastric tube, or melena associated with a fall in hemoglobin of more than 0.8 g/dl (not explained by hemodilution) or arterial hypotension after primary endoscopy.…”

Section: Methodsmentioning

confidence: 99%

“…TAE has been successfully used for bleeding control, especially in old and multimorbid patients [7]. The preventive mode of transarterial embolization (TAE) has been used successfully as an additional option to decrease the rebleeding rate after endoscopic hemostasis [8]. The goal of P-TAE is a reduction of flow in the ulcer area by embolization of large vessels, such as the left gastric artery or gastroduodenal artery, secondary to ulcer localization in the gastric fundus, antral, pyloric, or duodenal part avoiding a superselective embolization of the vessel feeding the ulcer.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience

et al. 2019

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Background Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed. Results From 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417. Conclusion P-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.

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“…A bridge between endoscopic and surgical intervention is endovascular coiling or transcatheter arterial embolization (TAE). This is an effective and safe method to control the bleeds or rebleeds after the failure of conventional endoscopic interventions with low mortality in patients with coagulation dyscrasias, antiplatelet therapies, liver dysfunction, and on chronic anticoagulation [4]. The typical indications for TAE include massive bleeding (transfusion requirement ≥ four units of blood per 24 h), hemodynamic instability secondary to blood loss, failure to conservative medical therapy [volume replacement, antacids, H2 receptor blocking agents, or proton pump inhibitors (PPIs), and have failed attempts for endoscopic intervention to control the bleeding] [5].…”

Section: Discussionmentioning

confidence: 99%

Use of Endovascular Coiling to Stop Gastric Ulcer Bleeding in a Patient With Extensive Risk Factors

Ali

Sana

Pamarthy

et al. 2021

Cureus

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Peptic ulcer disease (PUD) can lead to life-threatening bleeding. Endoscopy is a primary intervention used to locate the site of bleeding and maintain hemostasis. When considering multiple risk factors to operative intervention or failed initial endoscopic procedure in patients, the preferred treatment for acute gastrointestinal bleeding remains endovascular coiling to embolize the culprit's vessel. We report a case of a 57-year-old female who presents with melena secondary to gastric ulcer not amenable to endoscopic interventions. Various embolization techniques are available demanding clinicians' attention towards their role in managing ulcer bleeds and their impact on the controlling bleeds.

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Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes

Cited by 11 publications

References 46 publications

Endovascular treatment of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery as a complication of chronic pancreatitis: a case report

Endovascular treatment of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery as a complication of chronic pancreatitis: a case report

Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience

Use of Endovascular Coiling to Stop Gastric Ulcer Bleeding in a Patient With Extensive Risk Factors

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