Korean J Radiol.  2012 Feb;13(Suppl 1):S31-S39. 10.3348/kjr.2012.13.S1.S31.

Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

• Shin JH

• KMID: 1372865
• DOI: http://doi.org/10.3348/kjr.2012.13.S1.S31

Abstract

Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

Keyword

Upper gastrointestinal tract bleeding; Embolization; Embolic materials

MeSH Terms

Angiography
Embolization, Therapeutic/*methods
Endoscopy, Gastrointestinal
Gastrointestinal Hemorrhage/etiology/*therapy
Hemostasis, Endoscopic
Humans
*Upper Gastrointestinal Tract

Figure

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  Fig. 1 Three patterns of embolization according to embolization level for non-terminal (A) and terminal (B) arteries. In localized embolization (1), superselective embolization is done for bleeding point without embolizing other adjacent arteries. In proximal embolization (2), e.g. microcatheter-inaccessible bleeding point, only the artery proximal to the bleeding point is embolized. In segmental embolization (3), not only bleeding point but also adjacent branch artery or arteries are embolized together.

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  Fig. 2 63-year-old woman with pylorus-preserving pancreaticoduodenectomy for ampulla of Vater cancer. A. Celiac angiogram shows intraluminal bleeding (arrows) from gastroduodenal artery (GDA) stump to jejunal loops. B. Celiac angiogram immediately after microcoil embolization shows complete embolization of both proximal and distal portions of GDA stump. Note minimal collateral (arrowhead) from left gastric artery. C. Axial contrast-enhanced computed tomography scan one day after embolization shows multifocal hepatic infarctions (asterisks) in liver. D. Computed tomography follow-up one month after embolization shows complete disappearance of hepatic infarctions.

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  Fig. 3 54-year-old man with ERCP-induced pancreatitis. This patient had undergone embolization for bleedings from short gastric and left interior phrenic arteries. A. Superior mesenteric artery (SMA) angiogram shows pseudoaneurysm (arrow) at distal gastroduodenal artery. B. The tip (arrowhead) of microcatheter was advanced as far as to pseudoaneurysm (arrow), however, could not reach it. C. N-butyl cyanocrylate (NBCA) embolization (1 : 3 mixture with lipiodol) was done with NBCA cast covering pseudoaneurysm. D. Completion SMA angiogram shows no visualization of pseudoaneurysm. Hematochezia was controlled.

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  Fig. 4 65-year-old man with B-cell lymphoma presented with melena. A. Celiac angiogram shows contrast extravasation (arrows) from small branches of gastroduodenal artery. B, C. Long segmental embolization was done with N-butyl cyanocrylate (NBCA) to prevent back flow from the superior mesenteric artery. Spot radiograph (B) and superior mesenteric artery angiogram (C) show NBCA cast (arrowheads) without further bleeding. D. A computed tomography scan 4 days later showed bowel ischemia and perforation (arrows) with peritonitis surrounding radiopaque embolic material (arrowheads).

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