Dunne Ruth, McCarthy Eoghan, Joyce Eimear, McEniff Niall, Guiney Michael, Ryan J Mark, Beddy Peter
Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland.
Acta Radiol. 2013 Dec;54(10):1159-64. doi: 10.1177/0284185113491567. Epub 2013 Jul 26.
Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations.
To evaluate the technical and clinical success of transcatheter arterial embolization via micro coils in the management of bleeding post-endoscopic sphincterotomy (ES).
An 8-year retrospective review of all patients referred for transcatheter arterial embolization (TAE) for management of post-ES bleeding not controlled by endoscopy was performed. We analyzed the findings at endoscopy, angiography, interventional procedure, and the technical and clinical success.
Twelve embolization procedures were performed in 11 patients. Technical success was achieved in 11 of 12 procedures. Branches embolized included the gastroduodenal artery (GDA) in 11 cases, the superior pancreaticoduodenal artery (SPDA) in one case, and the inferior pancreaticoduodenal artery (IPDA) in four cases. Clinical success was achieved in 10 of 11 patients. One patient was referred for surgical intervention due to rebleeding from the IPDA.
Our experience demonstrates that TAE can effectively control bleeding post-ES avoiding the need for invasive surgery in most patients.
内镜括约肌切开术是内镜逆行胰胆管造影的一个重要组成部分。括约肌切开术后出血是一种公认的并发症。一线治疗包括在括约肌切开术时采用的多种内镜技术。如果这些方法不成功，经导管动脉栓塞术或开放性手术血管结扎术是可供考虑的治疗方法。
评估通过微线圈进行经导管动脉栓塞术在处理内镜括约肌切开术（ES）后出血方面的技术和临床成功率。
对所有因内镜括约肌切开术后出血经内镜治疗无效而转诊进行经导管动脉栓塞术（TAE）的患者进行了为期8年的回顾性研究。我们分析了内镜检查、血管造影、介入操作的结果以及技术和临床成功率。
对11例患者进行了12次栓塞手术。12次手术中有11次取得了技术成功。栓塞的分支包括11例胃十二指肠动脉（GDA）、1例胰十二指肠上动脉（SPDA）和4例胰十二指肠下动脉（IPDA）。11例患者中有10例取得了临床成功。1例患者因IPDA再次出血而转诊接受手术干预。
我们的经验表明，经导管动脉栓塞术可以有效控制内镜括约肌切开术后的出血，避免大多数患者进行侵入性手术。
