Transcatheter arterial embolization in the management of bleeding duodenal ulcers: A 5.5-year retrospective study of treatment and outcome

Larssen, Lene; Moger, Thomas; Bjørnbeth, Bjørn Atle; Lygren, Idar; Kløw, Nils Einar

doi:10.1080/00365520701676443

Cited by 85 publications

(56 citation statements)

References 17 publications

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“…Loffroy et al [13] , 2008 35 71 100 66 94 Larssen et al [15] , 2008 36 80 100 42 92 van Vugt et al [35] Loffroy R et al . Transcatheter arterial embolization in bleeding ulcers dissection of the target vessel, and hepatic or splenic infarction.…”

Section: Outcomes In Case-seriesmentioning

confidence: 99%

“…Surgery is associated with mortality rates as high as 20% to 40% [11] . Although endovascular management is not included in the treatment algorithms for UGI bleeding described in surgical textbooks, selective catheter-directed embolization has been proposed as a less hazardous alternative to surgery, especially for high-risk patients [12,13] , and is now considered in many institutions as the first-line intervention for massive gastroduodenal bleeding after failed endoscopic treatment [12][13][14][15] . The obvious advantage of transcatheter embolization is avoidance of a laparotomy in a critically ill patient.…”

Section: Introductionmentioning

confidence: 99%

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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: Outcomes In Case-seriesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Loffroy¹,

Guiu²

2009

WJG

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“…Furthermore, endoscopic treatments for active bleeding of the duodenal ulcer are more difficult because of the narrow lumen. Although there are some reports showing the effectiveness of TAE in the treatment of duodenal peptic ulcer hemorrhage uncontrolled by endoscopy [9][10][11][12], there are no reports showing how often TAE was performed in hemorrhagic ulcers caused by duodenal neoplasms, perhaps due to the low frequency of these tumors causing UGI bleeding (0.94 %) [4]. However, since TAE has gained widespread acceptance for acute arterial bleeding due to gastrointestinal tumors and it is generally preferred over surgery [5], we should consider TAE as rescue therapy if initial endoscopic treatment for duodenal ulcer fails.…”

Section: Discussionmentioning

confidence: 99%

Lethal hemorrhage from duodenal ulcer due to small pancreatic cancer

Higashiyama

Suzuki

Watanabe

et al. 2015

Clin J Gastroenterol

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Gastrointestinal massive arterial hemorrhage is difficult to stop endoscopically, especially from a duodenal ulcer (DU), because of the anatomically narrow lumen. Here we report a rare case of small pancreatic cancer-induced lethal hemorrhagic DU. The 69-year-old patient was transferred due to massive hematemesis, hypotension and loss of consciousness. Emergency upper endoscopy revealed a DU with active bleeding from an unclear hemorrhagic spot, which stopped transiently by itself. Subsequently he began to vomit blood again and angiography showed extravasation from the gastroduodenal artery (GDA). Hemostasis by transcatheter arterial embolization (TAE) was achieved but the patient unfortunately died soon after because of hemorrhagic shock (10 h after his first hematemesis). The autopsy revealed a small pancreatic cancer (poorly differentiated adenocarcinoma, 10 × 25 mm in size) infiltrating into one-half of the penetrating DU with a nearby ruptured GDA wall, suggesting that the DU was caused by the pancreatic cancer. Our 7-year analysis of emergency endoscopies in our department for upper gastrointestinal bleeding revealed that TAE was performed in more cases of duodenal hemorrhage (5.7 %) than stomach hemorrhage (1.8 %), showing the difficulty in stopping hemorrhage from DU endoscopically. This case raises the possibility that intractable lethal hemorrhagic DU could be caused by a very small pancreatic tumor.

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“…Therefore, endovascular embolization has generated interest as an alternative to surgery in high-risk patients with bleeding despite endoscopic treatment. The use of endovascular embolization is supported by the technical advances, high clinical success rates in our last study (95 and 71.9%, respectively) [3] as well as in all published case series over the last decade [4][5][6] . Consequently, we are very surprised in this study that angiography followed by arterial embolization was not systematically used first in patients who failed hemostasis after repeat endos-could have resulted in lower periprocedural morbidity and mortality.…”

mentioning

confidence: 88%

Refractory Bleeding from Peptic Ulcers: Is There Still a Role for Surgery?

Loffroy¹,

Guiu²

2009

Dig Surg

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Transcatheter arterial embolization in the management of bleeding duodenal ulcers: A 5.5-year retrospective study of treatment and outcome

Abstract: High technical and clinical success was obtained with TAE in patients with bleeding duodenal ulcer after failure of endoscopic treatment. TAE appears to be a treatment alternative to surgery in this group of patients.

Cited by 85 publications

References 17 publications

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Lethal hemorrhage from duodenal ulcer due to small pancreatic cancer

Refractory Bleeding from Peptic Ulcers: Is There Still a Role for Surgery?

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