Objectives

1. Demonstrate the decisive role of endovascular techniques in the treatment of nonvariceal upper gastrointestinal (UGI) bleeding.

2. Describe an educational guide for TAE, outlining the indications, techniques, complications and limitations.

Background

UGI hemorrhage is a major cause of morbidity and mortality despite numerous advances in diagnosis and treatment. The most common cause of UGI bleeding is peptic ulcer disease, but multiple etiologies must be taken into account. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, in some cases, surgical intervention may eventually become necessary, but it can be associated with high mortality rates. Endovascular management has emerged as an alternative to operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic.

Imaging findings OR Procedure findings

TAE is an effective and minimally invasive procedure, because of the diversified arteriographic manifestations of acute UGI haemorrhage and the proper selection of embolic agents. Selective catheterization of the artery thought to most likely supply the site of bleeding should be performed first. For UGI bleeding, this would be the celiac artery followed by the superior mesenteric artery. After locating the source of bleeding, appropriate embolic agents, such as coils or microcoils, gelatin sponge, PVA, gelatin particles etc., are used to embolize the targeted vessels.

Conclusion

Massive bleeding from the upper tract remains a challenge. The safety and efficacy of TAE for the treatment of life-threatening nonvariceal UGI bleeding is now widely accepted and is considered the gold standard for endoscopy-refractory patients.