Endoscopic ultrasound (EUS)-guided angiotherapyof refractory gastrointestinal bleeding

Michael J. Levy, Louis M. Wong Kee Song, Michael B. Farnell, Sanjay Misra, Michael G. Sarr, Christopher J. Gostout

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)352-359
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume103
Issue number2
DOIs
StatePublished - Feb 2008

Fingerprint

Hemorrhage
Gastrointestinal Stromal Tumors
Duodenal Ulcer
Patient Selection
Cyanoacrylates
False Aneurysm
Patient Care
Erythrocytes
Alcohols
Databases
Safety

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic ultrasound (EUS)-guided angiotherapyof refractory gastrointestinal bleeding. / Levy, Michael J.; Wong Kee Song, Louis M.; Farnell, Michael B.; Misra, Sanjay; Sarr, Michael G.; Gostout, Christopher J.

In: American Journal of Gastroenterology, Vol. 103, No. 2, 02.2008, p. 352-359.

Research output: Contribution to journalArticle

Levy, Michael J. ; Wong Kee Song, Louis M. ; Farnell, Michael B. ; Misra, Sanjay ; Sarr, Michael G. ; Gostout, Christopher J. / Endoscopic ultrasound (EUS)-guided angiotherapyof refractory gastrointestinal bleeding. In: American Journal of Gastroenterology. 2008 ; Vol. 103, No. 2. pp. 352-359.
@article{53180c85de0941f299039066c681fba6,
title = "Endoscopic ultrasound (EUS)-guided angiotherapyof refractory gastrointestinal bleeding",
abstract = "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.",
author = "Levy, {Michael J.} and {Wong Kee Song}, {Louis M.} and Farnell, {Michael B.} and Sanjay Misra and Sarr, {Michael G.} and Gostout, {Christopher J.}",
year = "2008",
month = "2",
doi = "10.1111/j.1572-0241.2007.01616.x",
language = "English (US)",
volume = "103",
pages = "352--359",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "2",

}

TY - JOUR

T1 - Endoscopic ultrasound (EUS)-guided angiotherapyof refractory gastrointestinal bleeding

AU - Levy, Michael J.

AU - Wong Kee Song, Louis M.

AU - Farnell, Michael B.

AU - Misra, Sanjay

AU - Sarr, Michael G.

AU - Gostout, Christopher J.

PY - 2008/2

Y1 - 2008/2

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=39049132071&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39049132071&partnerID=8YFLogxK

U2 - 10.1111/j.1572-0241.2007.01616.x

DO - 10.1111/j.1572-0241.2007.01616.x

M3 - Article

C2 - 17986314

AN - SCOPUS:39049132071

VL - 103

SP - 352

EP - 359

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 2

ER -