Emergency endoscopic treatment for massive upper gastrointestinal bleeding of patients after liver transplantation

Abstract

Objective To investigate the experience and effect of emergency endoscopic treatment for massive upper gastrointestinal bleeding (UGB) of patients after liver transplantation. Methods Clinical data of 3 patients with massive UGB after liver transplantation receiving emergency endoscopic treatment in Digestive Endoscopy Center, the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to December 2013 were analyzed retrospectively. All the patients were male with the age of 44, 54 and 61 years old, and all had symptoms of haematemesis, massive melena and shock to various degrees. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were prepared by fasting, supplementing blood volume, psychologically nursing before operation. And the endoscopic instruments, medicine and emergency rescue items were prepared. The patients were kept the airway clear, doctors and nurses well cooperated and the vital signs were closely observed. Clear endoscopic field was kept during the operation and appropriate hemostasis were performed according to different situations. The patients were sent back to bed-ward after they were stable after the operation and were handed over to the attending physician meticulously. Results For case 1, hemostatic clips were used to stop the active bleeding from contralateral bare vessels on the horn of duodenal bulb and a local injection of sclerosing agent was given. For case 2, the COOK ligator was used to ligate the esophageal varices rupture to stop the active bleeding, and tissue glue was injected at the bleeding spots of severe gastric fundus varices. The bleedings in case 1 and 2 were stopped successfully. For case 3, the stomach was filled with masses of blood clots and dark red blood and still couldn't be visible after being repeatedly washed and drainage. Thus the patient was urgently transferred to undergo embolization of the bleeding artery. This patient died of pulmonary infection, hemorrhagic shock and cardiac insufficiency after the operation. Conclusions Preoperative preparation should be well made during the emergency endoscopic hemostasis in patients with massive UGB after liver transplantation, and well cooperation of doctors and nurses, close observation on patients' condition, clear endoscopic field, appropriate hemostasis are necessary for improving the outcome. Key words: Liver transplantation; Postoperative hemorrhage; Gastrointestinal hemorrhage; Gastroscopy; Perioperative care