PMO-185 Duodenal tamponade: a case series and fourth modality in gastrointestinal bleed control

• Published in: Gut Vol. 61; no. Suppl 2; p. A149
• Main Authors: Gelsthorpe, A, Patodi, N, Ahmed, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.07.2012; BMJ Publishing Group LTD
• Subjects: Arthritis; Balloon treatment; Bleeding; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Duodenum; Endoscopy; Epinephrine; Femur; Fractures; Hemorrhage; Injection; Liver diseases; Medical innovations; Morbidity; Neck; Osteoarthritis; Renal failure; Rheumatoid arthritis; Tamponade; Ulcers
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2012-302514b.185

IntroductionThe mortalitiy associated with gastrointestinal bleeding is around 10%, a figure which has remained roughly constant despite continuing innovation in therapy. The use of injection, thermocoagulation, and endo-clips is widely practiced in the context of bleeding duodenal ulcers. However a number of patients will re-bleed in spite of dual or even triple therapy. In cases where co-morbidity precludes surgical intervention further therapeutic options may be non-existent.MethodsWe describe a case series of five patients with multiple co-morbidity who presented with upper gastrointestinal haemorrhage from duodenal lesions. A variety of therapeutic modalities were employed that is, injection with Adrenaline, thermocoagulation or endoclips. Unfortunately haemostasis was not achieved and surgical intervention deemed inappropriate. Our technique involves tamponade with a 18 mm CRE (constant radial expansion) balloon inflated in the duodenum. The gastroscope with the deflated balloon is passed via the pylorus. The balloon is then inflated keeping the proximal portion of the balloon under direct vision at all times to ensure correct placement. Tamponade is maintained for up to 50 min.ResultsThis procedure achieved haemostasis in all five cases. The tamponade was maintained for a total of between 10 and 50 min.ConclusionDuodenal tamponade to control Haemorrhage has been described previously only twice and has required either specialist equipment1 or surgical intervention.2 The CRE balloon is readily available within most endoscopy units and therefore no expenditure is required to use this new modality. In addition the technique is easily learnt and can be readily applied to lesions whose orientation makes targeted intervention difficult. Tamponade is a useful adjunct and may prove lifesaving in an otherwise hopeless situation.Competing interestsNone declared.References1. Rohatgi A, Houghton PW. Duodenal tamponade in the treatment of an intractable peptic ulcer bleed. Ann R Coll Surg Engl 2001;83:335–6.2. Taylor TV. Isolated duodenal tamponade for treatment of bleeding duodenal ulcer. Lancet 1988;1:911–12.Abstract PMO-185 Table 1PatientAgeCo-morbidityInitial endoscopic interventionTamponade in minutesOutcome177Rheumatoid arthritis recurrent fallsAdrenaline injection thermocoagulation50Survived and discharged288Renal failureAdrenaline endoclips three procedures in 4 days10Survived GI bleed but passed away from unrelated cause389Osteoarthritis, admitted with fractured neck of femurAdrenaline infection thermocoagulation10Survived and discharged479Alcoholic liver disease type 2 diabetesAwkwardly placed lesion at D1, injection with adrenaline only10Survived and discharged588Renal failureAdrenaline injection10Survived and discharged