Traitement par embolisation endovasculaire d’hémorragies gastro-intestinales hautes non variqueuses et aiguës après échec du traitement endoscopique

Chevallier, P.; Novellas, S.; Vanbiervliet, Geoffroy; Staccini, Pascal; Conte, L.; Hébuterne, Xavier; Bruneton, J.N.

doi:10.1016/s0221-0363(07)89811-8

Cited by 12 publications

(4 citation statements)

References 41 publications

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“…While empirical embolization is a method taken as a preventative measure for re-bleeding [ 9 ]. With the superselective catheterization of patients with GI bleeding, the percentage of positive angiography may increases to 93.4% [ 10 ]. However, it is noted that empirical embolization is controversial because of the increased possibility of re-bleeding and ischemia [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Bleeding Successfully Treated Using Interventional Radiology

Takeuchi¹,

Yoshitani²,

Soneda³

et al. 2017

Gastroenterol Res

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Gastrointestinal (GI) bleeding is an emergency medical condition that leads to hemorrhagic shock or circulatory instability if left untreated. A mainstay for treating GI bleeding is endoscopic therapy; more than 90% of GI bleeding can be staunched by endoscopic hemostasis. However, patients with unstable hemodynamics or GI bleeding that cannot be controlled by endoscopy require transcatheter embolization or surgical intervention. The development of several devices and embolization agents that are used in interventional radiology (IVR) leads to safe and accessible treatment via IVR. If endoscopic treatment fails, IVR is the second strategy. Herein, we report cases of GI bleeding that were successfully treated by IVR and discuss the therapeutic strategy.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal Bleeding Successfully Treated Using Interventional Radiology

Takeuchi¹,

Yoshitani²,

Soneda³

et al. 2017

Gastroenterol Res

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“…Charbonnet et al [2] reported a positive rate of 37% while survey by Zuckerman and Prakash [9] found that the rate of positive angiograms can vary from 27% to 77%. Chevallier and colleagues [21] reported very high percentage (93.4%) of positive angiographies which can be explained by the increased frequency of superselective catheter placement in these patients. Nevertheless an angiography may give normal results despite superselective catheterization because even a massive hemorrhage can be intermittent [4].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

Ali

Haq

Salam

et al. 2013

Radiology Research and Practice

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Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

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“…Various surgical techniques exist, especially for treating bleeding DU, ranging from local approaches (ulcers suture with or without extraluminal ligation of the GDA) to gastroduodenal resections (distal gastrectomy with partial duodenectomy). Nevertheless, surgery is still associated with high morbidity rates (∼50%) and high mortality rates (ranging from 18 to 40%) [60-62]. A meta-analysis including 6 studies showed a high pooled frequency of surgery-related complications of 46%, ranging from pneumonia, postoperative abscess, and duodenal stump leakage to multiorgan failure [63].…”

Section: Management Of Persistent Du Bleedingmentioning

confidence: 99%

Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers

2020

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Background: Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. Summary: This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. Key Messages: Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.

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Traitement par embolisation endovasculaire d’hémorragies gastro-intestinales hautes non variqueuses et aiguës après échec du traitement endoscopique

Cited by 12 publications

References 41 publications

Gastrointestinal Bleeding Successfully Treated Using Interventional Radiology

Gastrointestinal Bleeding Successfully Treated Using Interventional Radiology

Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers

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