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.
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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
SN - 0002-9270
VL - 103
SP - 352
EP - 359
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 2
ER -