Transcatheter arterial embolization for uncontrolled bleeding during endoscopic submucosal dissection of the stomach

Transarterial embolisation for gastroduodenal bleeding following endoscopic resection

OBJECTIVES

Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection.

METHODS

Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed.

RESULTS

Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up.

CONCLUSIONS

TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures.

ADVANCES IN KNOWLEDGE

This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.

A case of gastric pseudoaneurysm following endoscopic submucosal dissection of early gastric cancer

A woman in her 80s underwent endoscopic submucosal dissection (ESD) for a 20-mm-sized early gastric cancer lesion in the posterior wall of the upper gastric body. The lesion was resected en bloc with no adverse events. However, bleeding was observed in a post-ESD mucosal defect the day after ESD, so endoscopic hemostasis was performed. Moreover, hematemesis occurred 4 days after ESD, when the bleeding site showed a sign of pulsatile aneurysm. Therefore, endoscopic hemostasis was considered difficult, and angiographic treatment was chosen. Since angiography revealed a pseudoaneurysm in a portion of a branch of the left gastric artery, embolization with microcoils was performed. Thereafter, no bleeding occurred. To the best of our knowledge, there is no case report about the formation of a pseudoaneurysm in a post-gastric ESD mucosal defect. Thus, this case is being reported to document valuable information.