Arterial embolisation in management of massive bleeding from gastric and duodenal ulcers

Objective: We have tried angiography and selective arterial embolisation as a complement or another option in patients with massive bleeding from peptic ulcers who were considered poor candidates for surgery. Design: Prospective, descriptive Study. Setting: University hospital, Sweden. Patients: Since 1998, 18 patients (11 women) with a median age of 78 years (range 53-94) had selective arterial embolisation for uncontrollable bleeding from peptic ulcers. Intervention: Superselective angiographic catheterisation and embolisation of the arterial branch that was supplying the ulcer. Main outcome measures: The success rate of haemostasis and the overall outcome, Results: 13 patients were treated after failed endoscopic treatment to stop bleeding or to control recurrent bleeding after initial arrest, while 5 patients were treated for recurrent bleeding after emergency operations for Needing ulcers. Most of the ulcers were in the duodenum. The patients were haemodynamically unstable and had a median haemoglobin concentration of 72 g/L (50-98). Embolisation of the arterial branch that was supplying the ulcer was feasible in all Patients. Permanent haemostasis, was achieved in all but one patient, although two patients needed a second embolisation for recurrent bleeding. One patient had the bleeding controlled at an emergency operation, but eventually died of respiratory complications. There were no serious complications of embolisation. Conclusion: Angiographic embolisation may be an effective way to stop massive bleeding, from gastroduodenal ulcers. Emergency operations in poor surgical candidates can therefore be avoided.