Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
Troubleshooting and prevention of hemorrhagic adverse events during walled-off necrosis treatment
Yukitoshi Matsunami1, Shuntaro Mukai1, Takao Itoi1
1Department of Gastroenterology and Hepatology, Tokyo Medical University
(Background and study aims) Recently, the usefulness of interventional EUS for WON has been reported. However, hemorrhagic adverse events (AEs) can lead to fatal prognosis, and its troubleshooting is difficult. Herein, we report our treatment strategy, troubleshooting, and prevention for hemorrhagic AEs during WON treatment, with videos. (Patients and methods) The consecutive patients who underwent EUS drainage between the study period of 2006 Feb. to 2019 Apr. were retrospectively analyzed. (Results) Among the 176 patients, hemorrhagic AEs were seen in 23 patients (13%, 16 men, median age 61 years). 7 pseudoaneurysms were treated by interventional radiology (IVR) prior to EUS drainage. 5 cases of endoscopic procedure-related bleeding were successfully treated by endoscopic hemostasis (1 APC, 1 balloon dilation, 1 metal stenting, 1 aspiration of hematoma, 1 clipping). There were 11 cases of procedural interval bleeding, and 4 of them were attempted endoscopic hemostasis, however all of them were failed to hemostasis by endoscopy, and underwent emergent IVR. 10 of 11 were achieved hemostasis by IVR (8 coil embolization, 2 chemical embolization). Despite bleeding control were achieved, subsequent severe sepsis with multiple organ failure led the fatal course, and five were failed to survive. (Conclusion) Hemorrhagic AEs can be trigger for uncontrolled infection of WON cavity, which leads to fatal course. Therefore, appropriate prevention and troubleshooting are necessary to further improve the treatment outcomes.
Index Term 1: WON
Index Term 2: bleeding
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