Clinical effect of continuous gastric cooling for massive GI bleeding in uremia

Continuous gastric cooling (CGC) with dialysate was done in nine hemodiaysis patients with massive gastro-intestinal (GI) bleeding. Eight patients were treated by direct irrigation using a double-lumen naso-gastric (NG) tube without balloon. Four patients with bleeding from the duodenum (B-f-D) had complete hemostasis, and there was only one recurrence. However, two out of four patients with bleeding from the stomach (B-f-S) had complete hemostasis, but all four suffered recurrence. The NG tube had to be reinserted in three patients with B-f-S because of obstruction by clots. The direct irrigation method of CGC thus appears to be more effective for the treatment of B-f-D than B-f-S, so we investigated a three lumen, single-balloon catheter (3L-SBC) with which the bleeding site in the stomach can be cooled and pressed without removing coagula. CGC using the 3L-SBC was done in one patient with B-f-S, and complete hemostasis was obtained without recurrence.