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Updated: Jul 5, 2026
Application of Simplified Stent-bridging Pancreaticogastrostomy in Open Pancreaticoduodenectomy
Published on: March 17, 2026
Angiography is indicated for every sentinel bleed after pancreaticoduodenectomy
Yu-Wen Tien1, Yao-Ming Wu, Kao-Lang Liu
1Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China. ywt5106@ha.mc.ntu.edu.tw
Insights
Early angiography for sentinel bleeds after pancreaticoduodenectomy (PD) is crucial. This approach successfully identified pseudoaneurysms, reducing massive hemorrhage and mortality compared to historical controls.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Vascular Surgery
Background:
- Delayed massive bleeding is a major cause of mortality following pancreaticoduodenectomy (PD).
- Sentinel bleeds often precede massive hemorrhage, necessitating prompt diagnosis and intervention.
- Angiography is a key diagnostic and therapeutic tool for identifying bleeding sources and enabling embolization.
Purpose of the Study:
- To evaluate the efficacy of angiography as the primary management strategy for sentinel bleeds post-pancreaticoduodenectomy.
- To determine if early angiography reduces the incidence of delayed massive hemorrhage and associated mortality.
Main Methods:
- A study group of 283 patients undergoing PD (July 2002-June 2007) had angiography and embolization for sentinel bleeds.
- A historical control group of 311 patients (July 1996-June 2002) without routine angiography was used for comparison.
Main Results:
- Sentinel bleeds occurred in 20 patients; angiography detected pseudoaneurysms in seven (35%), all successfully embolized.
- Three of 13 patients with sentinel bleeds and negative angiography developed massive hemorrhage; one died.
- The study group showed significantly lower rates of hemodynamic instability, transfusion needs, and bleeding-related mortality compared to the control group.
Conclusions:
- Implementing angiography for all sentinel bleeds after PD allows for early pseudoaneurysm embolization, preventing massive hemorrhage.
- Routine angiography for sentinel bleeds significantly decreases bleeding-related mortality after pancreaticoduodenectomy.
Background:
Delayed massive bleeding is one of the leading causes of mortality after pancreaticoduodenectomy (PD) and is often preceded by sentinel bleed. Immediate and accurate diagnosis of sentinel bleed is essential to save patients from a delayed massive hemorrhage. Angiography is probably the procedure of choice for patients with sentinel bleed after PD, as it will localize the bleeding point and provide interventional embolization. The purpose of this study is to test the efficiency of angiography as the initial management for patients with sentinel bleed after pancreaticoduodenectomy.
Methods:
The study group consisted of 283 patients who underwent PD from July 2002 to June 2007. Angiography and arterial embolization were performed for every sentinel bleed and detected pseudoaneurysm. Patients (n = 311) from a previous study (July 1996-June 2002) were used as a historical control group.
Results:
Sentinel bleed was detected in 20 patients in study group. Of these, angiography-detected pseudoaneurysm was evident in seven (35%); all were successfully embolized. Delayed massive hemorrhage occurred in three of 13 patients with sentinel bleed but negative angiography. All three were operated on; one died of uncontrolled bleeding. The number of hemodynamically unstable patients before transfusion, units of transfused packed cells, and bleeding related mortalities were significantly less in study group than the control group.
Conclusions:
Institution of angiography for every detected sentinel bleed after PD enabled us to embolize seven pseudoaneurysms before massive hemorrhage. Most importantly, bleeding-related mortality was significantly less than in the absence of angiography.
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