Targeted arterial embolization in the treatment of gastrointestinal ulcer bleeding

The recurrence of bleeding that occurred after the use of therapeutic endoscopy remains the main problem in the treatment of gastroduodenal ulcer bleeding. Repeated endoscopic hemostasis with recurrent bleeding is accompanied by a greater likelihood of its resumption. The use of open surgical interventions with ongoing bleeding in case of ineffectiveness of therapeutic endoscopy and recurrence of bleeding does not improve the results of treatment of ulcerative bleeding. Purpose of the study. To evaluate the immediate results of the use of targeted arterial embolization for bleeding from chronic gastric and duodenal ulcers. Materials and methods. Transcatheter arterial embolization of the vessels of the stomach and duodenum was performed in 124 patients with ulcerative gastroduodenal bleeding. In 54.8% of cases, arterial embolization was performed for chronic gastric ulcer complicated by bleeding, in 45.2% of cases - for chronic duodenal ulcer. Arterial embolization was performed with a solution of N-butyl-2-cyanoacrylate, which was diluted with a radiopaque substance, which made it possible to see the embolized part of the artery during fluoroscopy. Results. The technical success of using targeted arterial embolization was 97.6% of cases, the clinical success was 95% of cases. Recurrence of bleeding was observed in 5% of patients, while in 2.5% of cases repeated arterial embolization was used to eliminate it. Postoperative complications occurred in 19.8% of patients. Delayed operations were performed in 8.3% of patients, mortality was 6.5% and was not associated with the use of arterial embolization. Conclusions. 1. Targeted arterial embolization is highly effective in ulcerative gastrointestinal bleeding and improves the results of their treatment. 2. Indications for the use of transcatheter arterial embolization in patients with ulcerative gastroduodenal bleeding are: ongoing bleeding with resistance to therapeutic endoscopy, rebleeding after endoscopic hemostasis, a high risk of rebleeding in a chronic ulcer after therapeutic endoscopy, and rebleeding after superselective arterial embolization.