Transcatheter control of intractible gastrointestinal bleeding

A series of 23 patients with intractible gastrointestinal (GI) bleeding were managed by the transcatheter method. The series included 5 with hemobilia, 8 with upper GI (UGI) bleeding, 5 with lower GI (LGI) bleeding and 5 with variceal bleeding. The etiology of the hemobilia was surgery, or percutaneous transhepatic cholangiography and drainage (PTCD) complicated by various degrees of biliary tract infection. The causes of UGI bleeding included erosive gastritis, gastric and duodenal ulcers, and traumatic duodenal laceration. All 5 LGI bleedings were due to ischemic colitis and all 5 variceal bleedings were due to hyperdynamic portal hypertension from arterio-portal (A-P) shunting for hepatocellular carcinomas (HCC). Intra-arterial vasopressin infusion was performed on 17 (4, hemobilia; 8, UGI; and 5 LGI bleeding) of these 23 cases as initial management. The success rate for vasopressin in hemobilia, UGI and LGI bleeding was 75% (3/4), 38% (3/8), and 60% (3/5), respectively. The overall initial success rate of vasopressin was 52% (9/17). The relatively poor success rate of vasopressin infusion for UGI bleeding was due to ulcers and laceration. The incidence of rebleeding for vasopressin infusion was 22% (2/9) including one case each of UGI and LGI bleeding. Three patients (1 hemobilia and 2 UGI bleeding) among these 17 cases underwent transarterial embolization (TAE) after failure of intra-arterial vasopressin infusion. One of these 23 cases with hemobilia underwent TAE for initial transcatheter control of the GI bleeding. Five cases of active esophageal variceal bleeding, caused by A-P shunting in HCC, were all successfully controlled by TAE.(ABSTRACT TRUNCATED AT 250 WORDS)