Korean J Radiol.  2012 Apr;13(2):174-181. 10.3348/kjr.2012.13.2.174.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

• Seo N
• Shin JH
• Ko GY
• Yoon HK
• Gwon DI
• Kim JH
• Sung KB

• KMID: 1245381
• DOI: http://doi.org/10.3348/kjr.2012.13.2.174

Abstract

OBJECTIVE
Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE).
MATERIALS AND METHODS
We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG.
RESULTS
The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE.
CONCLUSION
We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

Keyword

Percutaneous radiologic gastrostomy; Bleeding; Transcatheter arterial embolization

MeSH Terms

Adult
Aged
Aged, 80 and over
Embolization, Therapeutic/*methods
Female
Gastrointestinal Hemorrhage/diagnosis/*epidemiology/*therapy
*Gastrostomy
Humans
Incidence
Male
Middle Aged
Postoperative Hemorrhage/diagnosis/*epidemiology/*therapy
Retrospective Studies
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Thirty two-year-old male patient with nasopharyngeal cancer (patient No. 2). A. Superior mesenteric angiogram shows extravasation from branch of right gastroepiploic artery (arrows) adjacent to tube. Pseudoaneurysm (arrowhead) in splenic artery caused by septic emboli is also observed. Due to retrograde flow with celiac stenosis, gastroepiploic artery and splenic artery are visualized on superior mesenteric angiogram. B. Successful N-butyl cyanoacrylate embolization (arrows) was done by superselection of bleeding focus at common hepatic artery level.

• 

  Fig. 2 Eighty seven-year-old female who previously underwent surgical repair of aortic dissection (patient No. 4). A. Right gastroepiploic angiogram shows extravasation (arrows) at greater curvature of stomach near hemoclips (arrowhead). B. Embolization with gelfoam slurry and microcoils (arrow) was performed at proximal part of bleeding focus due to marked tortuosity of right gastroepiploic artery. Splenic angiogram shows no collateral flow from left gastroepiploic artery (not shown). Although post-embolization angiogram shows no further bleeding, patient underwent laparotomy due to uncontrolled bleeding.

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