Authors
Musinov I.M.1, Chikin A.E.2, Sandursky G.V.2, Kachesov E.Y.2
1 S.M. Kirov Military medical academy, St. Petersburg
2 Alexander Municipal Hospital, St. Petersburg
Abstract
The recurrence of bleeding that occurred after the use of therapeutic endoscopy remains the main problem in the treatment of gastroduodenal ulcer bleeding. Repeated endoscopic hemostasis with recurrent bleeding is accompanied by a greater likelihood of its resumption. The use of open surgical interventions with ongoing bleeding in case of ineffectiveness of therapeutic endoscopy and recurrence of bleeding does not improve the results of treatment of ulcerative bleeding.
Purpose of the study. To evaluate the immediate results of the use of targeted arterial embolization for bleeding from chronic gastric and duodenal ulcers.
Materials and methods. Transcatheter arterial embolization of the vessels of the stomach and duodenum was performed in 124 patients with ulcerative gastroduodenal bleeding. In 54.8% of cases, arterial embolization was performed for chronic gastric ulcer complicated by bleeding, in 45.2% of cases — for chronic duodenal ulcer. Arterial embolization was performed with a solution of N-butyl-2-cyanoacrylate, which was diluted with a radiopaque substance, which made it possible to see the embolized part of the artery during fluoroscopy.
Results. The technical success of using targeted arterial embolization was 97.6% of cases, the clinical success was 95% of cases. Recurrence of bleeding was observed in 5% of patients, while in 2.5% of cases repeated arterial embolization was used to eliminate it. Postoperative complications occurred in 19.8% of patients. Delayed operations were performed in 8.3% of patients, mortality was 6.5% and was not associated with the use of arterial embolization.
Conclusions. 1. Targeted arterial embolization is highly effective in ulcerative gastrointestinal bleeding and improves the results of their treatment. 2. Indications for the use of transcatheter arterial embolization in patients with ulcerative gastroduodenal bleeding are: ongoing bleeding with resistance to therapeutic endoscopy, rebleeding after endoscopic hemostasis, a high risk of rebleeding in a chronic ulcer after therapeutic endoscopy, and rebleeding after superselective arterial embolization.
Keywords: transcatheter arterial embolization, chronic gastric ulcer, chronic duodenal ulcer, bleeding.
References
1. Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann. Intern. Med. 2019; 171(11): 805-822. doi: 10.7326/M19-1795.
2. Sung JJY, Chiu PWY, Chan FKL, et al. Asia-pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Cut. 2019; 67(10): 1757-1768. doi: 10.1136/gutjnl-2018-316276.
3. Siau K, Hearnshaw S, Stanley AJ, et al. British society of gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding. Frontline Gastroenterol. 2020; 11(4): 311-323. doi: 10.1136/flgastro-2019-101395.
4. aine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Lancet. 2021; 116(5): 899-917. doi: 10.14309/ajg.0000000000001245.
5. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European society of gastrointestinal endoscopy (ESGE) guideline — update 2021. Endoscopy. 2021; 53(3): 300-332. doi: 10.1055/a-1369-5274.
6. Schmidt A, Gölder S, Goetz M, et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterol. 2018; 155(3): 674-686. doi: 10.1053/ j.gastro.2018.05.037.
7. Lau JY, Pittayanon R, Wong K-T, et al. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut. 2019; 68(5): 796-803. doi: 10.1136/gutjnl-2018-316074.
8. Tong H, Lan T, Tang CW. Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications? Gut. 2020; 69(10): 1897-1898. doi: 10.1136/gutjnl-2019-319818.
9. Chang JH, Lye TJ, Zhu HZ, et al. Systematic review and meta-analysis of prophylactic transarterial embolization for high-risk bleeding peptic ulcer disease. J. Vasc. Interv. Radiol. 2021; 32(4): 576-584. doi: 10.1016/ j.jvir.2020.12.005.
10. Spiliopoulos S, Inchingolo R, Lucatelli P, et al. Transcatheter arterial embolization for bleeding peptic ulcers: a multicenter study. Cardiovasc. Intervent. Radiol. 2018; 41(9): 1333-1339. doi: 10.1007/s00270-018-1966-4.
11. Chevallier O, Comby P-O, Guillen K, et al. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis. Diagn. Interv. Imaging. 2021; 102(7-8): 479-487. doi: 10.1016/j.diii. 2021.03.004.
12. Lan T, Tong H, Qian S, et al. Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding: A retrospective study. Medicine (Baltimore). 2021; 100 (11): e23855. doi: 10.1097/MD.0000000000023855.
13. Loffroy R, Desmyttere A-S, Mouillot T. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur. Radiol. 2021; 31(5): 3015-3026. doi: 10.1007/s00330-020-07427-y.
14. Yu Q, Funaki B, Navuluri R, et al. Empiric transcatheter embolization for acute arterial upper gastrointestinal bleeding: a meta-analysis. AJR Am. J. Roentgenol. 2021; 216(4): 880-893. doi: 10.2214/AJR.20.23151.
