Emergent embolization of the gastroduodenal artery in the treatment of upper gastrointestinal bleeding. The experience from a surgeon-initiated interventional program.
BACKGROUND
Intractable nonvariceal upper gastrointestinal bleeding (UGIB) is associated with significant morbidity and mortality. Endovascular therapy is an alternative to surgery for high-risk patients.


METHODS
Review of prospectively collected data from patients who underwent emergent gastroduodenal artery embolization for UGIB.


RESULTS
Eight patients (mean age 68.5 years) were identified. They all had significant comorbidities and were deemed to be at high risk for surgical intervention. Endoscopy was performed in 7 patients. Active extravasation was present at the time of embolization in 5 (62.5%) patients. The technical success and clinical response rates were each 100%. The 30-day mortality rate was 12.5%. [corrected] There were no procedure-related complications. During mean follow-up of 9 months, 1 patient developed recurrent bleeding that was managed conservatively.


CONCLUSIONS
Endovascular embolization is a safe alternative to open surgical intervention after failed endoscopic treatment for UGIB. Surgeons with endovascular skills can perform this procedure with superior results.
Burris
Jennifer M
JM
Michael E DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States.
Lin
Peter H
PH
Johnston
William F
WF
Huynh
Tam T
TT
Kougias
Panagiotis
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017546:Angioscopy / Q000379:methods; D004381:Duodenal Ulcer; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome