Transcatheter Embolotherapy in the Upper GI Tract Indications

In general, transcatheter embolotherapy in the upper GI tract is indicated in a patient who (1) is actively bleeding and not a good surgical candidate, (2) is a surgical candidate but refuses an operation, or (3) requires stabilization prior to surgery. "Emergency" surgery, if still required after embolization, may then become "elective." Whether or not emergency surgery is required necessitates an active dialogue between all physicians caring for the patient. Transcatheter embolotherapy may be used in patients with various sources of upper GI bleeding (Table 102-2).

POSTGASTRIC SURGERY

As mentioned earlier, present clinical and past surgical and medical histories are important. If a patient has had a prior Bilroth surgical procedure for ulcer disease, the normal arterial arcades (collateral blood supply) of the upper GI tract may be disrupted. Such collateral vessels may have been ligated during surgery. Transcatheter embolotherapy in such patients must be performed with caution because there is a greater risk of GI tract infarction. If embolotherapy must be performed, super-selective catheterization must be used. In the event of bowel infarction, the patient will require surgery.

Various options and their potential duration of "function" are shown in Table 102-3.

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