Prophylactic embolisation of the left gastric artery in cases with massive upper gastrointestinal haemorrhage with normal angiographic findings

Abstract 

Background and study aims

The management of massive upper gastrointestinal haemorrhage (UGIH) is problem ridden, especially if the arteriorgraphy shows no pathological findings. Percutaneous embolotherapy of the apparently normal gastric artery could provide a safe haemostatic effect. Our study is a descriptive one aimed to highlight the efficacy and safety of trans-arterial embolisation of the left gastric artery in six cases with massive UGIH and normal angiographic findings.

Patients and methods

From January 2004 to December 2008, we performed 24 embolisation procedures for treatment of patients with massive UGIH. All patients had significant bleeding and were referred for arteriography. The outcomes for nine patients having massive UGIH with normal angiographic findings were studied retrospectively. Six of these patients had undergone embolisation of the left gastric artery, whereas the remaining three exsanguinated before embolisation.

Results

Nine patients with massive UGIH, who had normal findings on arteriography, were selected to represent the study group. Three patients who did not undergo embolisation exsanguinated after arteriography and two of them died from massive haematemesis. All the six embolised cases showed cessation or marked decrease of bleeding. No major complications were reported during or after embolisation.

Conclusion

Left gastric artery embolisation may be a safe and effective method in controlling UGIH with normal angiographic findings, for which both, a large number of patients and a multi-centre study, are recommended.