Abstract
Endoscopic topical injection therapy has been used as a therapy of first choice for hemorrhagic gastric ulcer, and excellent therapeutic results have been obtained. In some patients with this condition, however, hemostasis is difficult to achieve with this therapy. In such patients, we have recently begun to apply transcatheter arterial embolization (TAE). Here we report endoscopic findings, angiographic findings and the hemostatic effect of TAE in 12 patients with hemorrhagic gastric ulcer in whom endoscopic hemos-tasis was difficult to achieve. Endoscopic findings were divided into two types: 1) Dieulaf oy's ulcer (exulceratio simplex ; Es) or similar lesion in 6 patients and 2) deep, wide ulcer in the remaining 6 patients. In all cases, the ulcer was located in the area supplied by the left gastric artery. Angiography revealed contrast material extravasation in 7 (58.3%) of 12 patients. The ruptured artery was the parietal branch in 5 patients, the ascending branch in a patient and the mucosal branch bifurcating from the ascending branch in a patient. The rupture of the parietal branch was noted in 4 patients of the Es group and was a characteristic finding. TAE was performed in 11 patients, and hemostasis was achieved in 9 (81.8%). Of these 9 patients, 5 showed permanent hemostasis, 1 was operated after hemostasis and 3 died of severe underlying disease in spite of successful hemostasis. The remaining 2 patients received urgent operation because of re-bleeding. In the 6 patients exhibiting with contrast material extravasation, hemostasis could be achieved by firm embolization of the ruptured artery. Of the 5 patients without extravasa-tion, 2 showed re-bleeding after TAE. Some patients developed mucosal bleeding or erosion after TAE, but no severe complications were observed. These results indicate that TAE is effective for hemostasis in patients with hemorrhagic gastric ulcer if endoscopic hemostasis is unsuccessful.
