Failed Endoscopic Therapy and the Interventional Radiologist: Non-Variceal Upper Gastrointestinal Bleeding

The exact site of nonvariceal upper gastrointestinal bleeding is not always visualized by endoscopy. In these instances, other modalities must be utilized to isolate and treat the bleeding site. Angiography and transcatheter embolization provide a nonoperative option for patients whose bleeding has either not been controlled or not identified under endoscopy. Technically successful transcatheter embolization has been shown to significantly reduce mortality in patients with UGI hemorrhage. Temporary embolization agents like Gelfoam and permanent agents like polyvinyl alcohol, cyanoacrylic glues, and coils are used to embolize bleeding lesions. In patients with UGI hemorrhage that do not demonstrate bleeding on angiography, some authors have advocated prophylactic embolization of the left gastric artery. Major complications are unusual. While embolotherapy may not always be a permanent cure, it may stabilize the patient until definitive therapy/surgery is performed.