title: Transcatheter arterial embolization for uncontrolled bleeding during endoscopic submucosal dissection of the stomach.
abstract: Bleeding during endoscopic submucosal dissection (ESD) is an important complication. Here, we report a case of early gastric cancer in which endoscopic hemostasis during ESD failed, hemostasis by transcatheter arterial embolization (TAE) was performed, and ESD was subsequently completed. ESD was scheduled for an 89-year-old male with a type IIa + IIc lesion located on the anterior wall of the gastric antrum. During ESD, bleeding started and then increased. Hemoclips were used but the bleeding could not be controlled. ESD could not be continued because of a poor field of vision. We decided on TAE for hemostasis of the bleeding. Celiac angiography clearly showed extravasation in a branch of the right gastric artery. TAE with a microcoil and gelfoam was performed through the right gastric artery. ESD was started again directly after TAE. We were able to completely resect the lesion with a good field of vision. No complications occurred after therapy. He was alive without recurrence at 18 months after ESD. Thus, TAE is suggested to be a useful hemostatic method during ESD.
authors.affiliation: Department of Internal Medicine, Fujimi-kogen Medical Center, Fujimi-kogen Hospital, 11100 Ochiai, Fujimi, Suwa-gun, Nagano, 399-0214, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Komatsu
authors.forename: Tomohito
authors.initials: T
authors.lastname: Matsushita
authors.forename: Kyo
authors.initials: K
authors.lastname: Kishimoto
authors.forename: Wataru
authors.initials: W
authors.lastname: Adachi
mesh_terms: D000369:Aged, 80 and over; D001158:Arteries; D016063:Blood Loss, Surgical; D002404:Catheterization; D004210:Dissection / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D013274:Stomach Neoplasms / Q000601:surgery*