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HELIOS Klinikum Erfurt


LINC 2015

Embolization treatment for

acute gastrointestinal

bleeding

S. Basche

HELIOS Klinikum Erfurt LINC 2015

GIB

Upper GIB

Ulcus

Varicosis

Mallory-Weiss-S

Cancer

Oesophagus

Gaster

Duodenum


GIB

Prognosis

- 80% of GI- bleedings suspend spontaneous

- 20% recidivate within 3 days after therapy

- Emergency operation up to 50 % (Mortality)


GIB

Category Activity of bleeding

Rezidiv bleeding

I Ia Ib II IIa IIb IIc III

Acute hemorrhage Spurting hemorrhage Oozing hemmorrhage Recent hemorrhage Visible vessel Adherent clot Hemantin on ulcer base Lesions without signs of

recent hemorrhage

90% 30%

50 – 100% 20 – 50%

< 5%

< 5%

Forrest classification


Recurrence bleeding (high risk)

• Depending on:

– Forrest Ia/Ib 55%

– Forrest II 14 - 36%

– ulceration size > 1cm

– Localisation (posterior wall)

– Age

– Comorbidities and drugs (anticoagulation)


Upper GIB

23 Pat. with duodenal bleeding

I. Langner et al. Emerg Radiolog. 2008

Coiling operativ

Ulcus duodenale 8 10

Pancreatitis 1 2

Unknown 2 0

secondary hemorrhage 3 2

Ischemia 0 0

Mortality 3 2

http://dict.leo.org/ende/index_de.html#/search=secondary&searchLoc=0&resultOrder=basic&multiwordShowSingle=on

http://dict.leo.org/ende/index_de.html#/search=hemorrhage&searchLoc=0&resultOrder=basic&multiwordShowSingle=on


GIB

n 69

Vessel n Coil Glue C + G Recurrence Comp.

A.

gastroduo.

56 32 9 15 6 0

SMA 4 0 4 0 0 1

A. lienalis 8 4 0 4 0 0

A. gastrica 1 0 1 0 0 0

Personal results, 2012


„blind TAE“

• It means:

– Patient after endoscopic therapy and high risk

for recurrence bleeding

– 28 patients

– technical success 100 %

– recurrence bleeding 2/28

Dr.med. Juliane Huber (2014)


GIB

Lower GIB

Tumor

Polyposis

Meckel - Divertikel

Divertikulitis

Morbus Crohn

Colitis Ulcerosa

Angiodysplasie

Infarct / Embolie

Duodenum

Jejunum

Ileum

Colon

Rectum


GIB

Symptoms

Haematemesis

Melaena

Haematochezie


Lower GIB

Long term resuts after TAE

n %

Embolisation 75 100

techn. success 73 97

Recurrence

bleeding

12 16

Ischemia 5 7

30d Mortality 8 11

secondary hemo

rrhage

8 11

T.Lipof et al. Dis Colon Rectum, 2008

Summary: TAE – first line therapy

http://dict.leo.org/ende/index_de.html#/search=secondary&searchLoc=0&resultOrder=basic&multiwordShowSingle=on




Case 1

Patient: f; 75 y

• severe GIB after clipping in duodenal ulcer

• Therapy:

Embolisation with Histoacryl / Lipiodol


Case 1


Case 2

Patient: m ; 64 y

• chronic repeated pancreatitis

• Tumor of pancreatic head

• severe GIB

• Therapy:

Coil- Embolisation


Case 2


Case 3

Patient: f ; 83 y

• repeated severe GIB

• Angiodysplasie of Colon

• Therapy:

Embolisation of four Feederarteries with glue


Case 3


Case 4

Patient: m ; 66 y

• after 2/3 Resektion in gastric cancer

• insufficient Anastomosis

• severe GIB out of sigmoid,

• coloskopic Therapy on diverticulosis not possible

• Therapy:

Embolisation of one Feederartery with glue


Case 4


Case 5

Patient: m ; 68 y

• acute pancreatitis

• acute abdominal pain

• respiratory insufficiency

• AMI

symptomatically growing aneurysm of A.lienalis

• Therapy:

Coil and glue embolisation


Case 5


Summary (Material)

• Coil (larger vessels)

• Glue (smaller vessels, target restriction)

• Covered stent

• Beads

• All together ?

• Whats the best???

• Your own experience


Conclusion

CONCLUSIO: endovascular at first

Endovaskular therapies of GIB

„questions“ - answers

Rekanalisation after Coiling ? Low risk of occluding procedures

Downer 2008,

Organ-Ischemia liver/ splenic/ pancreas ? Target restriction!

Sessa 2004, Chiesa 2005

Stent-Grafts in septic Aneurysm ? Unlimited indication

Sachdev 2006, Tulsyan 2007, deFreitas 2007, Rossi 2008

Long time patency of Stent-Grafts ? Sufficient evidence based

Kasirajan 2001, Gabelmann 2002, Sessa 2004, Rossi 2008

Secondary Aneurysma-Expansion (inflammatoric No valid data

etiology) ?



LINC 2015

Embolization treatment for

acute gastrointestinal

bleeding

S. Basche

helios klinikum erfurt - linc2015.cncptdlx.com · helios klinikum erfurt linc 2015 gib upper gib...

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