Clinical Endoscopy

Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography: Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2022;55(3):458-462. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.114

Abstract PDF Supplementary Material PubReader ePub

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.

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An unusual case of high gastrointestinal bleeding after Whipple surgery
E Dubois, R Geelen
Acta Gastro Enterologica Belgica.2024; 87(3): 430. CrossRef

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Biliary Self-Expandable Metal Stent Could Be Recommended as a First Treatment Modality for Immediate Refractory Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: Sun Young Moon, Jun Heo, Min Kyu Jung, Chang Min Cho; Clin Endosc 2022;55(1):128-135. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2021.057

Abstract PDF PubReader ePub: Background
/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaining hemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. We compared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding.
Methods
Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediate ERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding, change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis.
Results
A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusions were needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued by angioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min.
Conclusions
Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMS insertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has a role as rescue therapy when SEMS does not work effectively.

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A Rare Case of Coil Migration into the Duodenum after Embolization of a Right Colic Artery Pseudoaneurysm: Jeongmin Choi, Young Moon Kim; Clin Endosc 2021;54(6):920-923. Published online January 12, 2021; DOI: https://doi.org/10.5946/ce.2020.228

Abstract PDF PubReader ePub

Transcatheter arterial embolization is a safe and effective treatment for visceral artery aneurysms; nevertheless, some complications can occur. Coil migration to other organs after embolization is extremely rare, and only 16 cases have been reported previously. We report a rare case of coil migration to the duodenal lumen after embolization of a right colic artery pseudoaneurysm. To the best of our knowledge, this is the first case of coil migration after a right colic artery embolization. The patient exhibited no symptoms and was treated conservatively without any intervention. Some previous reports have demonstrated spontaneous coil passage and successful conservative management. Our case supports conservative treatment as the primary treatment for asymptomatic patients. Clinicians should assess the risks and benefits of coil removal in asymptomatic patients before performing any intervention.

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Case report: Duodenal obstruction caused by gastroduodenal artery pseudoaneurysm with hematoma: an unusual case and literature review
Yan-Yuan Zhou, Shao-Chung Wang, Chen-June Seak, Shu-Wei Huang, Hao-Tsai Cheng
Frontiers in Medicine.2023;[Epub] CrossRef
Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model
Grant Schroeder, Masoud Edalati, Gregory Tom, Nicole Kuntjoro, Mark Gutin, Melvin Gurian, Edoardo Cuniberto, Elisabeth Hirth, Alessia Martiri, Maria Teresa Sposato, Selda Aminzadeh, James Eichenbaum, Parvin Alizadeh, Avijit Baidya, Reihaneh Haghniaz, Roho
Journal of the Mechanical Behavior of Biomedical Materials.2022; 130: 105156. CrossRef
A case of coil migration into the colon after embolization of the spleno-renal shunt
Tomomi Sadamitsu, Fumikazu Koyama, Toshihiro Tanaka, Hiroyuki Kuge, Masayuki Sho
Techniques in Coloproctology.2022; 26(11): 923. CrossRef

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Endoscopic Management of Peptic Ulcer Bleeding: Recent Advances: Philip WY Chiu; Clin Endosc 2019;52(5):416-418. Published online August 13, 2019; DOI: https://doi.org/10.5946/ce.2018.182

Abstract PDF PubReader ePub

Bleeding peptic ulcers remained as one of the commonest causes of hospitalization worldwide. While endoscopic hemostasis serves as primary treatment for bleeding ulcers, rebleeding after endoscopic hemostasis becomes more and more difficult to manage as patients are usually poor surgical candidates with multiple comorbidities. Recent advances in management of bleeding peptic ulcers aimed to further reduce the rate of rebleeding through—(1) identification of high risk patients for rebleeding and mortality; (2) improvement in primary endoscopic hemostasis and; (3) prophylactic angiographic embolization of major arteries. The technique and clinical evidences for these approaches will be reviewed in the current article.

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Eco-Friendly Synthesized Carbon Dots from Chinese Herbal Medicine: A Review
Yusheng Zhao, Yucong Li, Dawei Li, Huageng Yuan, Chuanan Shen
International Journal of Nanomedicine.2025; Volume 20: 3045. CrossRef
Diagnostic yield of bidirectional endoscopy for iron deficiency anemia in young patients
Binyamin R. Abramowitz, Helena Saba, Ayse Aytaman, Daniel A. DiLeo, Bani Chander Roland
BMC Gastroenterology.2024;[Epub] CrossRef
Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef
Aspirin vs Clopidogrel: Antiplatelet Agent of Choice for Those With Recent Bleeding or at Risk for Gastrointestinal Bleed
Siddharth Gosavi, Gokul Krishnan, Raviraja V Acharya
Cureus.2023;[Epub] CrossRef
Effect of nano silver on gastroprotective activity against ethanol-induced stomach ulcer in rats
Ibrahim Abdel Aziz Ibrahim, Abbas I. Hussein, Mahmoud S. Muter, Abdulalah T. Mohammed, Morteta H. Al-Medhtiy, Suhayla Hamad Shareef, Peshawa Yunis Aziz, Nabaz Fisal Shakir Agha, Mahmood Ameen Abdulla
Biomedicine & Pharmacotherapy.2022; 154: 113550. CrossRef
Protective Effects of Radix Sophorae Flavescentis Carbonisata-Based Carbon Dots Against Ethanol‐Induced Acute Gastric Ulcer in Rats: Anti-Inflammatory and Antioxidant Activities
Jie Hu, Juan Luo, Meiling Zhang, Jiashu Wu, Yue Zhang, Hui Kong, Huihua Qu, Guoliang Cheng, Yan Zhao
International Journal of Nanomedicine.2021; Volume 16: 2461. CrossRef

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Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel: Chung-Jo Choi, Hyun Lim, Dong-Suk Kim, Yong-Seol Jeong, Sang-Young Park, Jeong-Eun Kim; Clin Endosc 2019;52(6):612-615. Published online May 20, 2019; DOI: https://doi.org/10.5946/ce.2019.020

Abstract PDF PubReader ePub

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%–15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

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Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series
Jiayu Ju, Ziyao Cheng, Qingliang Zhu, Mingming Deng, Hailong Zhang
Medicine.2023; 102(5): e32819. CrossRef
Rare but critical: Aberrant vascular communication leading to multiorgan ischemia after prophylactic gastroduodenal artery embolization for refractory upper gastrointestinal bleeding
Muhammad Ibrahim Saeed, Amna Subhan Butt, Jahanzeb Shahid, Junaid Iqbal
Radiology Case Reports.2023; 18(11): 3926. CrossRef
Gastric Bleeding Caused by Migrated Coil: A Rare Complication of Splenic Artery Coil Embolization
Tian Li, Bayan Alsuleiman, Manuel Martinez
Gastro Hep Advances.2022; 1(1): 67. CrossRef
Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer
Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning
Cureus.2021;[Epub] CrossRef
Management of Gastroduodenal Artery Pseudoaneurysm Rupture With Duodenal Ulcer Complicated by Coil Migration
Dennis Chang, Purvi Patel, Seth Persky, Joseph Ng, Alan Kaell
ACG Case Reports Journal.2020; 7(4): e00347. CrossRef
Persisting bleeding from the duodenal ulcer in patients with occlusion of the celiac trunk: a case report
Andrzej Żyluk, Samir Zeair, Janusz Kordowski, Ewa Gabrysz-Trybek
Polish Journal of Surgery.2020; 93(SUPLEMENT): 54. CrossRef

7,262 View
118 Download
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Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding: Ari Garber, Sunguk Jang; Clin Endosc 2016;49(5):421-424. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.110

Abstract PDF PubReader ePub

Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

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Functional and structural neurodegenerative activities of Ankaferd BloodStopper in a mouse sciatic nerve model
Ramazan Üstün, Elif Oğuz, Ayşe Şeker, Filiz Taspinar
Experimental and Therapeutic Medicine.2024;[Epub] CrossRef
Hemostatic powder for acute upper gastrointestinal bleeding: Recent research advances
Dong-Shuai Su, Cheng-Kun Li, Cong Gao, Xing-Shun Qi
World Chinese Journal of Digestology.2023; 31(7): 249. CrossRef
Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics
Zehong Yang, Lihong Chen, Ji Liu, Hua Zhuang, Wei Lin, Changlong Li, Xiaojun Zhao
Advanced Materials.2023;[Epub] CrossRef
The Reduction of After-Hours and Weekend Effects in Upper Gastro-intestinal Bleeding Mortality During the COVID-19 Pandemic Compared to the Pre-Pandemic Period
Sergiu Marian Cazacu, Adina Turcu-Stiolica, Dan Nicolae Florescu, Bogdan Ungureanu, Vlad Florin Iovanescu, Carmen Daniela Neagoe, Daniela Burtea, Amelia Valentina Genunche-Dumitrescu, Taina Elena Avramescu, Sevastita Iordache
Journal of Multidisciplinary Healthcare.2023; Volume 16: 3151. CrossRef
Hemostatic efficacy and safety of the hemostatic powder UI-EWD in patients with lower gastrointestinal bleeding
Boram Cha, Donghyun Lee, Jongbeom Shin, Jin-Seok Park, Gye-suk Kwon, Hyungkil Kim
BMC Gastroenterology.2022;[Epub] CrossRef
The Haemostatic Effects of Ankaferd Blood Stopper® on Mammalian Brain Parenchyma: An Experimental Study
Emrah EGEMEN, Ümit Akın DERE, Başak ÜNVER KOLUMAN, Yücel DOĞRUEL, Ahmet KOLUMAN, Batuhan BAKIRARAR, Nazlı ÇİL, Esin AVCI, Emine TURAL, Fatih YAKAR
Batı Karadeniz Tıp Dergisi.2022; 6(1): 31. CrossRef
Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum
Volodymyr Mamchych, Sergiy Vereshchagin, Volodymyr Maksymchuk, Dmytro Maksymchuk
EUREKA: Health Sciences.2021; (2): 37. CrossRef
Case Report: Peptic ulcer disease following short-term use of nonsteroidal anti-inflammatory drugs in a 3-year-old child
Alin Dumitru Ciubotaru, Carmen-Ecaterina Leferman
F1000Research.2021; 9: 419. CrossRef
PRELIMINARY PHYTOCHEMICAL ANALYSIS AND BIOLOGICAL EVALUATIONS OF MISOPATES ORONTIUM L.
S Akbar, S Ishtiaq
The Journal of Animal and Plant Sciences.2021; 31(5): 1520. CrossRef
Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray
Durayd Alzoubaidi, Mohamed Hussein, Radu Rusu, Duncan Napier, Selena Dixon, Johannes W. Rey, Cora Steinheber, Sina Jameie‐Oskooei, Martin Dahan, Bu Hayee, Shraddha Gulati, Edward Despott, Alberto Murino, Sharmila Subramaniam, Sulleman Moreea, Phil Boger,
Digestive Endoscopy.2020; 32(1): 96. CrossRef
Comprehensive Bioanalysis of Ultrahigh Molecular Weight, Highly Disperse Poly(ethylene oxide) in Rat via Microsolid Phase Extraction and RPLC-Q-Q-TOF Coupled with the MSALL Technique
Zhi Zhang, Hui Jiang, Yuyao Zhang, Di Zhang, John Paul Fawcett, Jingkai Gu
Analytical Chemistry.2020; 92(8): 5978. CrossRef
Case Report: Peptic ulcer disease following short-term use of nonsteroidal anti-inflammatory drugs in a 3-year-old child
Alin Dumitru Ciubotaru, Carmen-Ecaterina Leferman
F1000Research.2020; 9: 419. CrossRef
Helicobacter pylori–Negative MALT Lymphoma Presenting as a Massive Recurrent Gastrointestinal Hemorrhage
Prateek S. Harne, Samiran Mukherjee, Ted Achufusi, Dhruv Lowe, Divey Manocha
Journal of Investigative Medicine High Impact Case Reports.2020;[Epub] CrossRef
Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?
Durayd Alzoubaidi, Laurence B Lovat, Rehan Haidry
Frontline Gastroenterology.2019; 10(1): 35. CrossRef
New endoscopic techniques in treating gastrointestinal bleeding
Young Sin Cho
International Journal of Gastrointestinal Intervention.2018; 7(3): 131. CrossRef
First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study
Raffaele Manta, Santi Mangiafico, Angelo Zullo, Helga Bertani, Angelo Caruso, Giuseppe Grande, Francesco Paolo Zito, Benedetto Mangiavillano, Luigi Pasquale, Andrea Parodi, Bastianello Germanà, Gabrio Bassotti, Fabio Monica, Maurizio Zilli, Antonio Pisani
Endoscopy International Open.2018; 06(11): E1317. CrossRef
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D. Heresbach, A. Laquière
Acta Endoscopica.2017; 47(5): 281. CrossRef
Neuromuscular degenerative effects of Ankaferd Blood Stopper® in mouse sciatic nerve model
Ramazan Üstün, Elif Kaval Oğuz, Çağrı Delilbaşı, Ayşe Şeker, Filiz Taşpınar, Mehmet Reşit Öncü, Ahmet Regaip Oğuz
Somatosensory & Motor Research.2017; 34(4): 248. CrossRef
Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding
Jeong Hwan Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016; 16(4): 189. CrossRef

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Endoscopic Removal of a Migrated Coil after Embolization of a Splenic Pseudoaneurysm: A Case Report: Yoo Min Han, Jong Yeul Lee, Il Ju Choi, Chan Gyoo Kim, Soo-Jeong Cho, Jun Ho Lee, Hyun Beom Kim, Ji Min Choi; Clin Endosc 2014;47(2):183-187. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.183

Abstract PDF PubReader ePub

Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention.

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Successful peroral cholangioscopic extraction of migrated endovascular coils into the bile ducts 2 years following right hepatic artery pseudoaneurysm endovascular treatment
Landry Hakiza, Lucien Widmer, Ken Liu, Cyrille Frei, Konstantin Burgmann, Frank Seibold, Christoph Matter, Dominic Staudenmann
VideoGIE.2024; 9(8): 379. CrossRef
Development of an Injectable, ECM-Derivative Embolic for the Treatment of Cerebral Saccular Aneurysms
Seungil Kim, Kamil W. Nowicki, Keishi Kohyama, Aditya Mittal, Sangho Ye, Kai Wang, Taro Fujii, Shivbaskar Rajesh, Catherine Cao, Rohit Mantena, Marianna Barbuto, Youngmee Jung, Bradley A. Gross, Robert M. Friedlander, William R. Wagner
Biomacromolecules.2024; 25(8): 4879. CrossRef
Gastric Bleeding Caused by Migrated Coil: A Rare Complication of Splenic Artery Coil Embolization
Tian Li, Bayan Alsuleiman, Manuel Martinez
Gastro Hep Advances.2022; 1(1): 67. CrossRef
Down to the Wire: A Case of Gastrointestinal Bleeding After Splenic Artery Coiling
John P. Haydek, Augustin R. Attwell
ACG Case Reports Journal.2022; 9(7): e00835. CrossRef
Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer
Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning
Cureus.2021;[Epub] CrossRef
Wire from the major papilla: Migration of endovascular coil into the main pancreatic duct
Sho Kitagawa, Shori Ishikawa, Hiroyuki Miyakawa
Digestive Endoscopy.2021;[Epub] CrossRef
Injectable hydrogels for vascular embolization and cell delivery: The potential for advances in cerebral aneurysm treatment
Seungil Kim, Kamil W. Nowicki, Bradley A. Gross, William R. Wagner
Biomaterials.2021; 277: 121109. CrossRef
A Rare Case of Coil Migration into the Duodenum after Embolization of a Right Colic Artery Pseudoaneurysm
Jeongmin Choi, Young Moon Kim
Clinical Endoscopy.2021; 54(6): 920. CrossRef
Embolization coil migration in the stomach and spontaneous excretion: a case report and review of the literature
Yasuo Matsubara, Lay Ahyoung Lim, Yasuki Hijikata, Yoshihiro Hirata, Hiroshi Yotsuyanagi
Radiology Case Reports.2020; 15(7): 1018. CrossRef
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ACG Case Reports Journal.2020; 7(10): e00472. CrossRef
Clinical Outcome of the Visible Coil During Endoscopy After Transcatheter Arterial Embolization for Gastrointestinal Bleeding
Jong-Joon Shim, Hee Ho Chu, Ji Hoon Shin, Jong Woo Kim, Do Hoon Kim, Hwoon-Yong Jung, Ji Yong Ahn
CardioVascular and Interventional Radiology.2019; 42(11): 1537. CrossRef
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W. Preston Hewgley, David L. Webb, H. Edward Garrett
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Laparoscopic endoscopic combined surgery for removal of migrated coil after embolization of ruptured splenic artery aneurysm
Akshay Pratap, Bhavani Pokala, Luciano M Vargas, Dmitry Oleynikov, Vishal Kothari
Journal of Surgical Case Reports.2018;[Epub] CrossRef
Coil Migration to the Duodenum 1 Year Following Embolisation of a Ruptured Giant Common Hepatic Artery Aneurysm
Yoshikatsu Nomura, Yasuko Gotake, Takuya Okada, Masato Yamaguchi, Koji Sugimoto, Yutaka Okita
EJVES Short Reports.2018; 39: 33. CrossRef
Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report
Junhwan Kim, Danbi Lee, Kyunghwan Oh, Mingee Lee, Seol So, Dong-Hoon Yang, Chan-Wook Kim, Dong Il Gwon, Young-Hwa Chung
The Korean Journal of Gastroenterology.2017; 69(1): 74. CrossRef
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Soondoos Raashed, Manju D Chandrasegaram, Khaled Alsaleh, Glen Schlaphoff, Neil D Merrett
BMC Surgery.2015;[Epub] CrossRef

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Refractory Gastrointestinal Bleeding: Role of Angiographic Intervention: Ji Hoon Shin; Clin Endosc 2013;46(5):486-491. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.486

Abstract PDF PubReader ePub

Although endoscopic hemostasis remains initial treatment modality for nonvariceal gastrointestinal (GI) bleeding, severe bleeding despite endoscopic management occurs in 5% to 10% of the patients, requiring surgery or transcatheter arterial embolization (TAE). TAE is now considered the first-line therapy for massive GI bleeding refractory to endoscopic management. GI endoscopists need to be familiar with indications, principles, outcomes, and complications of TAE, as well as embolic materials available.

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Prashant Nagpal, Bari Dane, Ayaz Aghayev, Kathryn J. Fowler, Sandeep S. Hedgire, Twyla B. Bartel, Brooks D. Cash, Jeremy D. Collins, David S. Kirsch, Hao S. Lo, Jason A. Pietryga, Beth Ripley, Cynthia S. Santillan, David H. Kim, Michael L. Steigner
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Persisting bleeding from the duodenal ulcer in patients with occlusion of the celiac trunk: a case report
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Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases
Yuan Zhao, Gang Li, Xiang Yu, Ping Xie
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A Case of Dieulafoy's Lesion with Pseudoaneurysm in the Sigmoid Colon: Tae Wan Kim, M.D., Hong Joo Kim, M.D., Jae Hoon Min, M.D., Sun Jeong Byun, M.D., Ji Ae Lee, M.D., Seung Hun Jang, M.D. and Sung Youn Choi, M.D.; Korean J Gastrointest Endosc 2010;41(5):303-307. Published online November 30, 2010

Abstract PDF: Dieulafoy's lesions are characterized by a single large tortuous arteriole in the submucosa, and this arteriole does not undergo normal branching. These lesions are an uncommon cause of massive, sometimes fatal gastrointestinal bleeding; this had been reported to be the cause of 0.3∼1.5% of the cases of major gastrointestinal bleeding. The lesions mainly occur in the proximal stomach, but they may occur in all parts of the gastrointestinal tract, including the small bowel, colon and rectum. Endoscopy is a common method for the diagnosis and treatment of Dieulafoy's lesions. However, in the case of a high risk lesion, angiography, laparoscopy or laparotomy can be performed instead. We experienced a rare case of bleeding from a Dieulafoy's lesion with pseudoaneurysm in the sigmoid colon. Angiography with embolization was performed, but the patient expired due to rebleeding. We report on this case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;41:303-307)

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A Case of Successful Embolization with Superselection by Endoscopic Hemoclipping for Pseudoaneurysmal Bleeding in a Patient with Pylorus Preserving Pancreaticoduodenectomy: Yong Hun Kim, M.D., Chang-Il Kwon, M.D., Sae Kyung Joo, M.D., Won Hee Kim, M.D., Hong Gern Bin, M.D., Man Deuk Kim, M.D. and Seong Gyu Hwang, M.D.; Korean J Gastrointest Endosc 2010;41(1):31-35. Published online July 31, 2010

Abstract PDF: Arterial bleeding after pancreaticoduodenectomy is a very serious complication with high mortality. Therefore, early diagnosis and treatment is essential. In particular, early detection and immediate embolization can be effectively used for the delayed massive bleeding that occurs from a pseudoaneurysmal rupture. However, sometimes intermittent bleeding or a vessel spasm can cause the bleeding focus to remain unidentified in spite of repeated angiography. We experienced a case of successful embolization with superselection by endoscopic hemoclipping in a patient who underwent pylorus preserving pancreaticoduodenectomy, and the patient's bleeding focus was not found after repeated angiography. Endoscopic hemoclip application can be useful for localizing a pseudoaneurysmal rupture in patients with pancreaticoduodenectomy. (Korean J Gastrointest Endosc 2010;41:31-35)

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A Case of Splenic Pseudoaneurysmal Rupture Misrecognized as Bleeding from Gastric Submucosal Tumor: Kwang Jae Lee, M.D., Tae Yeong Lee, M.D., Young Seok Bae, M.D., Dong Wan Kim, M.D., Jung Bin Yoon, M.D., Sang Hoon Bae, M.D., Dong Hyun Kim, M.D. and Seok Reyol Choi, M.D.*; Korean J Gastrointest Endosc 2010;40(6):387-390. Published online June 30, 2010

Abstract PDF: Splenic arterial pseudoaneurysm is an uncommon life-threatening complication of acute and chronic pancreatitis. Pseudoaneurysm can lead to massive bleeding into the abdominal cavity and the retroperitoneum. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present as an acute gastrointestinal hemorrhage. It can be diagnosed by various imaging modalities including computerized tomography, ultrasound and angiography. Percutaneous transvascular embolization of the pseudoaneurysm is one of the alternative treatment methods. Here we present a case of splenic arterial pseudoaneurysmal rupture misrecognized as bleeding from a gastric submucosal tumor in patient with hematemesis. We also review the literature. (Korean J Gastrointest Endosc 2010;40:387-390)

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A Case of Ruptured Left Gastric Artery Pseudoaneurysm Complicating Percutaneous Endoscopic Gastrostomy (PEG): Seong Hun Hong, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D. and Deok Ho Nam, M.D.*; Korean J Gastrointest Endosc 2009;39(1):34-37. Published online July 30, 2009

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure. (Korean J Gastrointest Endosc 2009;39:34-37)

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Common Bile Duct Obstruction Caused by Tumor Thrombus after Trans-arterial Chemoembolization in a Hepatocellular Carcinoma Patient: Hoon Choi, M.D., Suk Bae Kim, M.D., Ki Chul Shin, M.D., Hyun Duk Shin, M.D., Se Young Yun, M.D., Jung Eun Shin, M.D., Hong Ja Kim, M.D. and Il Han Song, M.D.; Korean J Gastrointest Endosc 2009;38(5):299-302. Published online May 30, 2009

Abstract PDF: The jaundice in hepatocellular carcinoma patient can be found when the tumor progresses or hepatic function deteriorates. Rarely, it can be occurred when the bile duct is obstructed. The main reason of obstructive jaundice in hepatocellular carcinoma is bile duct invasion of tumor, tumor thrombus, blood clot of hemobilia and direct bile compression by tumor or metastatic lymph node. Although the tumor thrombi among them is difficult to think, prompt diagnosis and treatment should be done because the symptom and prognosis can be improved by removal of the tumor thrombus. We experienced a case of hepatocellular carcinoma patient associated with obstructive jaundice caused by tumor thrombus after transarterial chemoembolization (TACE). The tumor thrombus was removed by endoscopic retrograde cholangiopancreatography (ERCP) and confirmed as degenerated hepatocellular carcinoma cell. (Korean J Gastrointest Endosc 2009;38:299-302)

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A Case of a Foreign Body in the Common Bile Duct Caused by Lipiodol: Kwan Woo Nam, M.D., Dae Soon Kwon, M.D., Hee Seok Moon, M.D., Seok Hyun Kim, M.D., Byung Seok Lee, M.D., Heon Young Lee, M.D., Jae Kyu Seong, M.D. and Hyun Yong Jeong, M.D.; Korean J Gastrointest Endosc 2008;37(2):156-158. Published online August 30, 2008

Abstract PDF: Finding a foreign body in the common bile duct (CBD) is very rare. Transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma and metastatic liver tumors, and especially when the tumors are not surgically resectable. We experienced a patient with a CBD foreign body 47 days after performing TACE for single hepatic metastasis of adrenal cortical carcinoma. The foreign body in the common bile duct was high attenuated on the pre-enhanced computed tomography (CT) and it was not observed on the previous CT. We successfully extracted it via a basket after performing endoscopic sphincterotomy; this foreign body was dark black color, flexible and smooth. It was not observed on the follow-up CT scan after one month. The foreign body in the common bile duct was tumor tissue that contained lipiodol and it was near the bile duct. We report here on a rare case of a foreign body in the common bile duct, and it was caused by lipiodol after performing TACE. (Korean J Gastrointest Endosc 2008;37:156-159)

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A Case of Non-traumatic Hemobilia due to Pseudoaneurysm of the Hepatic Artery: Gwon Hyun Cho, M.D., Jong Jun Lee, M.D., Sang Kyun Yu, M.D., Kwang An Kwon, M.D., Dong Kyun Park, M.D., Yeon Suk Kim, M.D., Yang Suh Ku, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2006;33(3):173-177. Published online September 30, 2006

Abstract PDF: Hemobilia is a cause of obscure gastrointestinal hemorrhage. Most cases have an iatrogenic or traumatic origin but cases of hemobilia with non-traumatic causes are rare. The non-traumatic causes of hemobilia are inflammation, gallstones, neoplasm and vascular lesions. Currently, various therapeutic options are available for hemobilia, and transarterial embolization is now the first line of intervention used to stop the bleeding of hemobilia, which shows a high success rate of approximately 80% to 100% with a lower morbidity and mortality rate than with surgery. We report a rare case of non-traumatic hemobilia caused by a pseudoaneurysm of the hepatic artery that was successfully treated with transarterial embolization. (Korean J Gastrointest Endosc 2006;33: 173⁣177)

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Rupture of a Bleeding Pancreatic Pseudocyst into the Stomach: a Case Report: Young Don Kim, M.D., Byung Kyu Nah, M.D., Jung Won Hwang, M.D., Hyun Il Hong, M.D., Sung Kyu Yoon, M.D., Koon Hee Han, M.D., Hye Young Choi, M.D., Kwang Seok Kim, M.D., Jae Hong Ahn, M.D.* and Gab Jin Cheon, M.D.; Korean J Gastrointest Endosc 2005;31(4):273-277. Published online October 30, 2005

Abstract PDF: Pancreatic pseudocyst is a well-known complication of pancreatitis. However spontaneous perforation and/or fistularization is rare. Perforations into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, and through the abdominal wall have been reported. Rupture of pseudoaneurysm or bleeding pseudocyst following pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Especially, rupture of a bleeding pseudocyst into the stomach combined with splenic artery pesudoaneurysm is very rare. We experienced a case of massive bleeding from pancreatic pseudocyst with pseudoaneurysmal rupture into the stomach which was controlled nonoperatively by splenic artery coil embolization and conservative treatment. We report the case with the literatures review. (Korean J Gastrointest Endosc 2005;31:273⁣277)

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Endoscopically Exposed Coil after Embolization for Bleeding Duodenal Ulcer: Young Chul Jo, M.D., In Du Jeong, M.D., Kun Hyung Cho, M.D., Su Jin Sin, M.D., Hyun Soo Kim, M.D., Hyo Sup Lee, M.D., Jeong Woo Shin, M.D., Sung Jo Bang, M.D., Neung Hwa Park, M.D., Jae Cheol Hwang, M.D.* and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2005;30(1):39-42. Published online January 30, 2005

Abstract PDF: Endoscopy has been the method of choice for the initial diagnosis and treatment of gastrointestinal bleeding. However, in the case of difficult localization or endoscopic failure, angiographic or surgical alternative may be recommended. The role of angiography has been emphasized recently to control upper GI bleeding. We experienced a case with deep ulcer displaying exposed vessel along the duodenal bulb, which imposed serious rebleeding risk. Although, active bleeding was controlled by the epinephrine injections in that patient, rebleeding risk was still high. So the patient underwent emergency angiography with embolization of the pancreaticoduodenal artery and gastroduodenal artery using multiple microcoils. Follow-up endoscopic examinations showed a coil protruding into the lumen from the ulcer bed, and the exposed coil at the ulcer base was completely by the regenerated epithelium three months later. Here in, we describe the rare case of a endodcopically exposed coil after embolization for bleeding duodenal ulcer which is the first case ever reported in Korea. (Korean J Gastrointest Endosc 2005;30:39⁣42)

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내시경적 용종 절제술로 치료한 십이지장 팽대부 선종 2예: Korean J Gastrointest Endosc 2003;27(5):496-496. Published online November 20, 2003

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A Clinical Study on the Effect of Transcatheter Arterial Embolization in the Treatment of Peptic Ulcer Bleeding: Jun Sik Cho, M.D., Jun Pyo Chung, M.D., Kwang-Hun Lee, M.D.*, Sung Woo Choi, M.D., Sang Won Ji, M.D., Jung Il Lee, M.D., Se Joon Lee, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Ki Whang Kim, M.D.*; Korean J Gastrointest Endosc 2003;26(3):125-132. Published online March 31, 2003

Abstract PDF: Background
/Aims: Transcatheter arterial embolization (TAE) has been increasingly used in the treatment of patients with gastrointestinal bleeding due to improved catheter and guidewire technologies and emergence of safer embolization materials. We evaluated the clinical characteristics of patients in whom TAE was performed and the outcome of the treatment. Methods: Eleven patients (M：F=9：2, mean age=60.6 years) underwent TAE between April 2001 and August 2002. Causes of bleeding were gastric ulcer in 9 cases and duodenal ulcer in 2 cases. Seven patients had comorbid diseases, but 4 patients did not. Results: Successful TAE without rebleeding was achieved in 10 of 11 patients (90.9%). One patient failed to respond to TAE and died due to multiorgan failure. Another patient died due to other causes despite a successful TAE. There were no TAE-related complications. Conclusions: TAE is a safe and effective modality in the treatment of patients with peptic ulcer bleeding who do not respond to endoscopic hemostasis. Thus, TAE seems to be included in the treatment algorithm of peptic ulcer bleeding regardless of surgical risks of patients and be placed before surgery, but prospective randomized studies are needed. (Korean J Gastrointest Endosc 2003;26:125⁣132)

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증례 / 담도경을 통한 알코올 주입술이 유용했던 활달형 간세포암 ( Icteric Type Hepatocelluar Carcinoma for Which Cholangioscopic Ethanol Injection Was Effective ): Korean J Gastrointest Endosc 2001;22(3):187-191. Published online November 30, 2000

Abstract PDF: Hepatocellular carcinoma often invades the portal or hepatic veins, but rarely proliferates in the bile duct. Since curative resection is rarely possible in these cases, conservative therapy has been the sole modality. Herein, we report a case of icteric type hepatocellular carcinoma for which cholangioscopic ethanol injection was effective. By only transcatheter arterial chemoembolization in this patient, obstructive jaundice and intermittent cholangitis were not relieved. Therefore, we performed ethanol injection into the intraductal hepatoma mass under percutaneous transhepatic cholangioscopic guidance. As a result of therapy, he had been well without jaundice and cholangitis for 9 months until die. (Korean J Gastrointest Endosc 2001;22:187 - 191)

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