Short- and long-term results of transcatheter embolization for massive arterial hemorrhage from gastroduodenal ulcers not controlled by endoscopic hemostasis
R Loffroy | B Guiu | L Mezzetta | A Minello | C Michiels | JL Jouve | N Cheynel | P Rat | J-P Cercueil | D Krausé
BACKGROUND AND AIM: Severe bleeding from gastrointestinal
ulcers is a life-threatening event that is difficult to manage when
endoscopic treatment fails. Transcatheter embolization has been suggested
as an alternative treatment in this situation. The present study
reports on the efficacy and long-term outcomes of transcatheter
embolization after failed endoscopic treatments were assessed in high operative-
METHODS: A retrospective review of 60 consecutive emergency
embolization procedures in hemodynamically unstable patients
(41 men, 19 women; mean [±SD] age 69.4±15 years) was conducted.
Patients were referred for selective angiography between 1999 and
2008 after failed endoscopic treatment of massive bleeding from gastrointestinal
ulcers. Mean follow-up was 22 months.
RESULTS: Embolization was feasible and successful in 57 patients.
Sandwich coiling of the gastroduodenal artery was used in 34 patients,
and superselective occlusion of the terminal feeding artery (with glue,
coils or gelatin particles) was used in 23 patients. Early rebleeding
occurred in 16 patients and was managed with endoscopy (n=8), reembolization
(n=3) or surgery (n=5). No major embolization-related
complications occurred. Sixteen patients died within 30 days after
embolization (including three who died from rebleeding) and 11 died
thereafter. No late bleeding recurrences were reported.
CONCLUSIONS: Selective angiographic embolization is safe and
effective for controlling life-threatening bleeding from gastroduodenal
ulcers. The procedure usually obviates the need for emergency
surgery in these high-risk patients. Survival depends chiefly on underlying