Transcatheter Therapeutic Embolization in the Management of Massive Upper Gastrointestinal Bleeding

Ml, Goldman; Wc, Land; El, Bradley; Rt, Anderson

doi:10.1148/120.3.513

Cited by 79 publications

(9 citation statements)

References 28 publications

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“…First-line endoscopy achieves bleeding control in as many as 98% of patients [3,4] . Despite these measures, the mortality rate in patients with bleeding peptic ulcers remains as high as 5% to 10% [5,6] due to a combination of advanced age, multiple co-morbidities, and high transfusion requirements [7] . Current treatment algorithms for massive UGI bleeding recommend aggressive correction of coagulation disorders followed by endoscopy [8,9] .…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Loffroy¹,

Guiu²

2009

WJG

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“…Since then several reports [2][3][4] have advocated this modality as a safe alternative to surgery. However, ischemic necrosis is a potential hazard in such cases.…”

mentioning

confidence: 99%

Colonic ischemic necrosis following therapeutic embolization

Shenoy

Satchidanand

Wesp

1981

Gastrointest Radiol

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“…Treatment by embolization of the gastroduodenal ar teries has been proposed with good results [34], and may be of interest in limited vascular diseases of the gastric vessels [56,57], However, when most of the gastric walls are affected by large arteriovenous communications, sur gical treatment must be done [58], The limits of surgical resection depend on the angiographic findings and, if necessary, intra-operative selective arteriography should be performed, even though the lesions are difficult to identify at operation [4,59,60]. Moreover, an important point may be to perform the anastomosis far from the angiodysplasia.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Malformation of the Stomach

Hamelin¹,

Carmona²,

Triguero³

et al. 1988

Dig Surg

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A wide range of vascular anomalies occurs in the gastrointestinal tract, the most specific being those of hereditary haemorrhagic telangiectasia. However, single gastric angiodysplasias are being recognised with increased frequency as an important cause of upper gastrointestinal bleeding. We present a case of gastric arteriovenous malformation, and review the general features that differentiate single gastric angiodysplasia from other vascular anomalies and syndromes associated with gastric vascular disease. Further reports are needed to confirm that gastric angiodysplasias constitue a unique and separate entity. If so, successful management should be obtained by resection of the whole angiodysplastic area.

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Transcatheter Therapeutic Embolization in the Management of Massive Upper Gastrointestinal Bleeding

Cited by 79 publications

References 28 publications

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

Colonic ischemic necrosis following therapeutic embolization

Arteriovenous Malformation of the Stomach

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