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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

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Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach.

Ruth Dunne¹, Eoghan McCarthy, Eimear Joyce

¹Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland.

Acta Radiologica (Stockholm, Sweden : 1987)

|July 30, 2013

Summary

Transcatheter arterial embolization (TAE) effectively manages bleeding after endoscopic sphincterotomy (ES) when endoscopic methods fail. This minimally invasive procedure avoids surgery in most patients, demonstrating high technical and clinical success rates for post-sphincterotomy hemorrhage control.

Keywords:

Transarterial embolization endoscopic sphincterotomy upper gastrointestinal bleed

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Area of Science:

Gastroenterology
Interventional Radiology
Vascular Surgery

Background:

Endoscopic sphincterotomy (ES) is a key procedure in ERCP.
Post-sphincterotomy hemorrhage is a known complication.
Endoscopic techniques are first-line management, with TAE or surgery as alternatives.

Purpose of the Study:

To assess the efficacy of transcatheter arterial embolization (TAE) using microcoils for post-ES bleeding.
To evaluate technical and clinical success rates of TAE in this context.

Main Methods:

Retrospective review of 11 patients undergoing TAE for post-ES bleeding unresponsive to endoscopy.
Analysis of endoscopic findings, angiography, and interventional procedure outcomes.

Main Results:

12 TAE procedures were performed in 11 patients.
Technical success was 11/12; clinical success was 10/11.
Gastroduodenal artery embolization was common; one patient required surgery for rebleeding.

Conclusions:

TAE is an effective treatment for post-ES bleeding.
It successfully controls hemorrhage, often obviating the need for surgery.