Document Detail

Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding.
MedLine Citation:
PMID:  17986314     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There are well-established methods for treating gastrointestinal (GI) bleeding, although some lesions prove refractory to conventional techniques. Little consideration has been directed toward the use of endoscopic ultrasound (EUS) in the management of refractory bleeding. AIMS: To discuss patient selection, technique, and clinical outcomes for EUS-guided angiotherapy for severe refractory bleeding after conventional therapies. METHODS: The EUS database was reviewed to identify all patients who underwent EUS-directed angiotherapy. RESULTS: Five patients, four with severe bleeding from hemosuccus pancreaticus, Dieulafoy lesion, duodenal ulcer, or gastrointestinal stromal tumor (GIST) and one with occult GI bleeding, had an average of three prior episodes (range 2-4) of severe bleeding and had received 18 (range 14-25) units of packed red blood cells (PRBC). All had failed in at least two conventional attempts to control the bleeding. Under EUS guidance, 99% alcohol was injected (4-7 mL) in two patients, one each with a pancreatic pseudoaneurysm and a duodenal Dieulafoy lesion. In three other patients, cyanoacrylate (3-5 mL) was injected into a duodenal ulcer, and in two patients with a GIST. No patient rebled and no complications were reported. CONCLUSIONS: EUS-guided angiotherapy appears safe and effective in managing selected patients with clinically severe or occult GI bleeding from lesions potentially refractory to standard endoscopic and/or angiographic techniques. Further studies are needed to confirm the safety and efficacy and to refine the selection criteria in an effort to improve patient care.
Michael J Levy; Louis M Wong Kee Song; Michael B Farnell; Sanjay Misra; Michael G Sarr; Christopher J Gostout
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-11-06
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  103     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-21     Completed Date:  2008-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  352-9     Citation Subset:  IM    
Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, MN 55905, USA.
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MeSH Terms
Aged, 80 and over
Gastrointestinal Hemorrhage / therapy*
Middle Aged
Severity of Illness Index

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