To determine technical and clinical results of transcatheter arterial embolization of endoscopically unmanageable nonvariceal gastrointestinal hemorrhage (GIH).

Gastrointestinal bleeding remains a frequent clinical dilemma, often with poor outcomes despite multi-disciplinary treatment. Multiple etiologies for NUGB have been described. Peptic ulcer disease contributes to 50-75 % of the common causes of NUGB including duodenal ulcers, gastric ulcers, and erosive esophagitis/gastritis. Fig. 1 Before the development of therapeutic endoscopy, 35-55 % of patients with massive NUBG required emergency surgery, which was associated with a 20 % mortality. With the development of therapeutic endoscopy, emergency surgery is actually needed in only 5 % of cases...

Angiographic technique for the diagnosis of NUBG requires selective angiograms of the celiac and superior mesenteric arteries. A femoral approach is utilized to gain access to the arterial tree. Embolotherapy is performed after diagnostic angiography even if no adtive bleeding is demosnstrated.A superselective angiogram of the left gastric artery is usually performed in cases in which bleeding is expected in the fundus of the stomach and superselective angiogram of the gastroduodenal artery is often performed in cases of suspected duodenal bleeding. This technique provides a...

High technical and clinical success was obtained with transcatheter arterial embolization in patients with bleeding duodenal ulcer after failure of endoscopic treatment. Transcatheter arterial embolization appears to be a treatment alternative to surgery in this group of patients, especially in patients with risk factors for recurrent bleeding and death that are also related to high surgical risk.

Fig. 9