Type:
Educational Exhibit
Keywords:
Obstruction / Occlusion, Haemorrhage, Acute, Venous access, Embolisation, Arterial access, Fluoroscopy, CT-Angiography, Catheter arteriography, Interventional vascular, Gastrointestinal tract, Abdomen
Authors:
D. Kontogom1, D. CABRAL2, N. ZHANG3, S. Binsse4, J. Sellier5, M. Sirol6, R. Y. Carlier1, P. Lacombe4, M. El Hajjam4; 1Garches/FR, 2Poissy/FR, 3Caen/FR, 4Boulogne-Billancourt/FR, 5Poitiers/FR, 6Paris/FR
DOI:
10.26044/ecr2019/C-3595
Conclusion
Management of gastrointestinal bleeding is primarily endoscopic according to the predominance of peptic ulcer disease with a great success rate (85 to 90%). In case of failure of a first endoscopy,
a second must be attempted,
with as much as possible the “marking” of the bleeding site by clips.
After two unsuccessful endoscopic treatment attempts,
are positioned interventional radiology with embolization and surgery,
guided by angioscan,
with similar results. Embolization should be preferred to surgery especially in patients at risk because of co-morbidities and coagulopathy.
Angioscan is the key examination to perform. The interventional procedure is facilitated by a good vascular mapping provided by the angio-scanner and by the endoscopic identification of the hemorrhagic site with clips. Embolization should reach the site of bleeding,
obstruct the responsible artery and take into account the anastomotic nature of the digestive tract to prevent recurrence.
Post-embolization monitoring should allow early detection of possible ischemic complications including pancreatic. The angioscan-embolization pair performs well in the localization of bleeding and the treatment of persistent upper gastrointestinal bleeding or recurrent after therapeutic endoscopy.
The ongoing technical progress of micro-catheterization has increased the therapeutic effectiveness of embolization and reduced its morbidity.
Embolization has a prominent place and should be favored especially in patients at high surgical risk.
It also overcomes the inadequacies or impossibility of endoscopic treatment.