title: Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding.
abstract: BACKGROUND
  There are well-established methods for treating gastrointestinal (GI) bleeding, although some lesions prove refractory to conventional techniques. Little consideration has been directed toward the use of endoscopic ultrasound (EUS) in the management of refractory bleeding.
  
  
  OBJECTIVE
  To discuss patient selection, technique, and clinical outcomes for EUS-guided angiotherapy for severe refractory bleeding after conventional therapies.
  
  
  METHODS
  The EUS database was reviewed to identify all patients who underwent EUS-directed angiotherapy.
  
  
  RESULTS
  Five patients, four with severe bleeding from hemosuccus pancreaticus, Dieulafoy lesion, duodenal ulcer, or gastrointestinal stromal tumor (GIST) and one with occult GI bleeding, had an average of three prior episodes (range 2-4) of severe bleeding and had received 18 (range 14-25) units of packed red blood cells (PRBC). All had failed in at least two conventional attempts to control the bleeding. Under EUS guidance, 99% alcohol was injected (4-7 mL) in two patients, one each with a pancreatic pseudoaneurysm and a duodenal Dieulafoy lesion. In three other patients, cyanoacrylate (3-5 mL) was injected into a duodenal ulcer, and in two patients with a GIST. No patient rebled and no complications were reported.
  
  
  CONCLUSIONS
  EUS-guided angiotherapy appears safe and effective in managing selected patients with clinically severe or occult GI bleeding from lesions potentially refractory to standard endoscopic and/or angiographic techniques. Further studies are needed to confirm the safety and efficacy and to refine the selection criteria in an effort to improve patient care.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, MN 55905, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wong Kee Song
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.forename: Sanjay
authors.initials: S
authors.lastname: Misra
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index