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Role of transcatheter arterial embolization for massive bleeding from gastroduodenal ulcers

World Journal of Gastroenterology 2009年第47期15卷 5889-5897页

作者： Romaric Loffroy Boris Guiu The Russell H Morgan Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology The Johns Hopkins Hospital 600 North Wolfe Street Blalock 545 BaltimoreMD 21287 United States Division of Vascular and Interventional Radiology University of Dijon School of Medicine Bocage Teaching Hospital 2 bd du Maréchal de Lattre de Tassigny BP 77908 21079 Dijon Cedex France

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 gastroduo-denal 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.

关键词： Peptic ulcer massive bleeding Endoscopy Angiography Embolization

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Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding

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World Journal of Gastroenterology 2009年第45期15卷 5740-5745页

作者： Bing-Ling Zhang You-Hong Fang Chun-Xiao Chen You-Ming Li Zun Xiang Department of Gastroenterology The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou 310003 Zhejiang Province China The Children's Hospital College of MedicineZhejiang University 57 Zhugan Lane Yanan Road Hangzhou 310003 Zhejiang Province China

AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ***: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

关键词： Obscure gastrointestinal bleeding Capsule endoscopy massive bleeding Chronic recurrent overt occult bleeding

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