Arterial embolisation in management of massive bleeding from gastric and duodenal ulcers.

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.