Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding.
OBJECTIVE
To enable accurate transcatheter arterial embolization (TAE) of the target vessel, a new technique to localize the exact position of a bleeding ulcer was tested that involves endoscopic marking of the ulcer with a metallic clip.


METHODS
In 13 patients (mean age, 75 years) with acute bleeding ulcers (11 duodenal ulcers, two malignant ulcers), a metallic clip was placed at gastroscopy followed or preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. In 10 patients, TAE was indicated as a result of continued or recurrent bleeding. The artery was embolized with microcoils as close as possible to the clip. In three patients, there was no indication for TAE, so plain abdominal radiography was performed to determine whether the marking clip was still in place.


RESULTS
In 11 patients, the clip was still in place on radiography; in two, it had disappeared. Hemostasis was achieved in eight of 10 patients after TAE. In six patients, the clip was essential to identify the bleeding vessel.


CONCLUSIONS
Marking of the bleeding ulcer with a clip before TAE enhances the possibility that the correct vessel is embolized. This will most likely minimize the risk of recurrent bleeding after embolization, especially in patients who do not show contrast medium extravasation.
Eriksson
Lars-Gunnar
LG
Department of Radiology, Akademiska Sjukhuset, SE-751, 85 Uppsala, Sweden. lars-gunnar.eriksson@akademiska.se
Sundbom
Magnus
M
Gustavsson
Sven
S
Nyman
Rickard
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D015641:Radiography, Interventional; D013525:Surgical Instruments; D016896:Treatment Outcome
D003287:Contrast Media