. The recurrence of bleeding that occurred after the use of therapeutic endoscopy remains the main problem in the treatment of gastroduodenal ulcer bleeding. Repeated endoscopic hemostasis with recurrent bleeding is accompanied by a greater likelihood of its resumption. The use of open surgical interventions with ongoing bleeding in case of ineffectiveness of therapeutic endoscopy and recurrence of bleeding does not improve the results of treatment of ulcerative bleeding. Purpose of the study. To evaluate the immediate results of the use of targeted arterial embolization for bleeding from chronic gastric and duodenal ulcers. Materials and methods. Transcatheter arterial embolization of the vessels of the stomach and duodenum was performed in 124 patients with ulcerative gastroduodenal bleeding. In 54.8% of cases, arterial embolization was performed for chronic gastric ulcer complicated by bleeding, in 45.2% of cases — for chronic duodenal ulcer. Arterial embolization was performed with a solution of N-butyl-2-cyanoacrylate, which was diluted with a radiopaque substance, which made it possible to see the embolized part of the artery during fluoroscopy.Results. The technical success of using targeted arterial embolization was 97.6% of cases, the clinical success was 95% of cases. Recurrence of bleeding was observed in 5% of patients, while in 2.5% of cases repeated arterial embolization was used to eliminate it. Postoperative complications occurred in 19.8% of patients. Delayed operations were performed in 8.3% of patients, mortality was 6.5% and was not associated with the use of arterial embolization.Conclusions. 1. Targeted arterial embolization is highly effective in ulcerative gastrointestinal bleeding and improves the results of their treatment. 2. Indications for the use of transcatheter arterial embolization in patients with ulcerative gastroduodenal bleeding are: ongoing bleeding with resistance to therapeutic endoscopy, rebleeding after endoscopic hemostasis, a high risk of rebleeding in a chronic ulcer after therapeutic endoscopy, and rebleeding after superselective arterial embolization.

Targeted arterial embolization in the treatment of gastrointestinal ulcer bleeding

Outcomes of Transarterial Embolization for Acute Non-Variceal Upper Gastrointestinal Bleeding: Correlation with Periprocedural Endoscopy.

The management of peptic ulcer bleeding is clinically challenging. For decades, the Forrest classification has been used for risk stratification for nonvariceal ulcer bleeding. The perception and interpretation of the Forrest classification vary among different endoscopists. The relationship between the bleeder and ulcer images and the different stages of the Forrest classification has not been studied yet. Endoscopic still images of 276 patients with peptic ulcer bleeding for the past 3 years were retrieved and reviewed. The intra-rater agreement and inter-rater agreement were compared. The obtained endoscopic images were manually drawn to delineate the extent of the ulcer and bleeding area. The areas of the region of interest were compared between the different stages of the Forrest classification. A total of 276 images were first classified by two experienced tutor endoscopists. The images were reviewed by six other endoscopists. A good intra-rater correlation was observed (0.92–0.98). A good inter-rater correlation was observed among the different levels of experience (0.639–0.859). The correlation was higher among tutor and junior endoscopists than among experienced endoscopists. Low-risk Forrest IIC and III lesions show distinct patterns compared to high-risk Forrest I, IIA, or IIB lesions. We found good agreement of the Forrest classification among different endoscopists in a single institution. This is the first study to quantitively analyze the obtained and explain the distinct patterns of bleeding ulcers from endoscopy images.

/pdf/forrest-classification-for-bleeding-peptic-ulcer-a-new-look-6e7hc991.pdf

Forrest Classification for Bleeding Peptic Ulcer: A New Look at the Old Endoscopic Classification

Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding: A retrospective study.

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Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding: A retrospective study.