Massive arterial hemorrhage from the stomach and lower esophagus: impact of embolotherapy on survival.

The authors retrospectively reviewed the clinical courses in 36 patients referred for angiographic evaluation of massive arterial hemorrhage from the stomach, gastroesophageal junction, and lower esophagus. Twenty-four patients underwent embolotherapy, and 12 were treated with nontranscatheter therapy such as surgery, Sengstaken-Blakemore tube placement, endoscopic submucosal injection of epinephrine, or supportive medical therapy. Bleeding was controlled completely in 15 (62%) and partially in three (13%) of the patients who underwent embolotherapy. In nine of the patients treated with nontranscatheter therapy (75%), bleeding control was complete. Sixteen patients died, including seven of 28 in whom bleeding was controlled. There was no significant difference in the mortality rates of patients treated with nontranscatheter therapy (46% and 42%, respectively). Survival correlated with the clinical condition at the time of intervention. All patients with multiorgan failure died, while 87% of the other patients, even those with serious cardiovascular compromise, survived. The results imply that massive gastric hemorrhage should be treated aggressively, before it results in multiorgan failure.