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Arterial embolisation in management of massive bleeding from gastric and duodenal ulcers
Mikael Ljungdahl1, Lars-Gunnar Eriksson, Rickard Nyman
1Department of Surgery, University Hospital, Uppsala, Sweden.
Objective:
We have tried angiography and selective arterial embolisation as a complement or another option in patients with massive bleeding from peptic ulcers who were considered poor candidates for surgery.
Design:
Prospective, descriptive study.
Setting:
University hospital, Sweden.
Patients:
Since 1998, 18 patients (11 women) with a median age of 78 years (range 53-94) had selective arterial embolisation for uncontrollable bleeding from peptic ulcers.
Intervention:
Superselective angiographic catheterisation and embolisation of the arterial branch that was supplying the ulcer.
Main Outcome Measures:
The success rate of haemostasis and the overall outcome.
Results:
13 patients were treated after failed endoscopic treatment to stop bleeding or to control recurrent bleeding after initial arrest, while 5 patients were treated for recurrent bleeding after emergency operations for bleeding ulcers. Most of the ulcers were in the duodenum. The patients were haemodynamically unstable and had a median haemoglobin concentration of 72 g/L (50-98). Embolisation of the arterial branch that was supplying the ulcer was feasible in all patients. Permanent haemostasis was achieved in all but one patient, although two patients needed a second embolisation for recurrent bleeding. One patient had the bleeding controlled at an emergency operation, but eventually died of respiratory complications. There were no serious complications of embolisation.
Conclusion:
Angiographic embolisation may be an effective way to stop massive bleeding from gastroduodenal ulcers. Emergency operations in poor surgical candidates can therefore be avoided.
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