Transcatheter embolization for the control of upper digestive bleeding

Digestive bleeding (GDHB) is a relevant clinical problem. Digestive bleeding is self-limiting in 80%, but with a mortality rate between 6 and 10%. Transcatheter embolization, also known as embolization therapy, has evolved as a key therapeutic technique in the management of upper gastrointestinal bleeding (UGIB), especially in those cases refractory to endoscopic treatment. Clinical case: 73-year-old female patient with one day of evolution of 3 episodes of melena. In 2019 and 2022 she was hospitalized for digestive bleeding requiring an ICU stay and the use of multiple blood transfusions, a mesenteric vessel angiography (celiac trunk) in 2019 was reported as normal. The 2019 EVDA was found to be normal. Another endoscopy in 2022 reported a minor curve ulcer in the healing process. Because re-bleeding occurred and the EVDA did not locate the bleeding site but reported blood in the stomach and duodenum, mesenteric vessel angiography was requested. The angiography reported hypervascular blush in the topography of the short gastric, gastroepiploic and left gastric arteries, treated with embolization of the left gastric and gastroduodenal arteries with coils and microparticles. The patient progresses without bleeding and is discharged on the eleventh day of hospitalization. CONCLUSION: The international clinical practice guidelines for upper gastrointestinal bleeding (UGIB) recommend: In patients with persistent bleeding that does not respond to standard endoscopic hemostasis modalities, consider transcatheter embolization (TAE) as the next therapeutic option. If TAE is not available locally or fails, surgery should be considered as an alternative.