Efficacy of Transcatheter Arterial Embolotherapy for Patients with Massive Gastroduodenal Hemorrhage

概要

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Endoscopic hemostasis is thought to be the hemostatic procedure of first choice for the treatment of gastrointestinal bleeding. We retrospectively investigated accumulated data on 261 patients who underwent emergency endoscopic hemostatic therapy at our department over a 10-year period. Endoscopic hemostasis was successful in 94.3% (246/261) of the patients. Initial hemostasis was achieved in 158 patients (98.1%) in the haemoclip group and 88 patients (88%) who received an of the injection of 100% ethanol or were in the HSE (Hypertonic Saline-Epinephrine) group. In some patients, however, hemostasis was difficult to achieve with endoscopic therapy. We have recently begun to apply TAE (Transcatheter Arterial Embolization) in such patients. An angiography was performed in 6 patients in whom endoscopic hemostasis had failed, and hemostasis using TAE and microcoils was successfully performed. The ruptured artery was a branch of the left gastric artery in 3 patients and a branch of the pancreaticoduodenal artery in 3 patients. One patient developed an erosion after TAE, but no severe complications were observed. These results indicate that TAE, a nonsurgical and therefore less invasive procedure, is effective for hemostasis in patients with gastroduodenal hemorrhage if endoscopic hemostasis is unsuccessful.
日本腹部救急医学会の論文