Percutaneous Radiologic Gastrostomy Research Articles

A Meta-analysis and Systematic Review Comparing Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiologic Gastrostomy

Introduction: Different insertion techniques have been used for insertion of percutaneous gastrostomy tube. The aim of this study is to compare the efficacy, complications and mortality of gastrostomy tube insertion by endoscopic and radiological technique by performing a systematic review and meta-analysis. Methods: Pubmed, Embase and Cochrane databases were searched for published controlled studies comparing percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in human subjects. Quality for each included study was assessed by consort system. Heterogeneity of the studies was analyzed by Cochran's Q statistics. Mantel Haenszel odd ratio were calculated with random effects model. No language or date restrictions were applied. Results: 15 comparative studies on PEG and PRG met our inclusion criteria were used for our metaanalysis involving 2112 patients (1053 PEG, 1059 PRG). Our study found that PRG tube blockage and mortality was higher than PEG with odd ratio (OR): 0.29, (95% CI: 0.10, 0.86) and OR: 0.39, (95% CI: 0.19, 0.80) respectfully. However, there was no significant difference between endoscopic and radiologic techniques in terms of tube dislodgment (OR: 1.01, 95% CI: 0.32, 3.13), leakage (OR: 0.50, 95% CI: 0.20, 1.29), local bleeding (OR: 0.63, 95% CI: 0.14, 2.92), local infection (OR: 0.72, 95% CI: 0.21, 2.43) or peritonitis (OR 0.37, 95% CI: 0.13, 1.04). Conclusion: Our study indicates that PEG is superior to PRG in mortality and tube blockage. However, we cannot rule out the possibility that some of these differences may be related to patient selection bias and tube size used in PRG thus further large randomized trials comparing PEG and PRG will be necessary.

Percutaneous Endoscopic Gastrostomy in Amyotrophic Lateral Sclerosis

Percutaneous endoscopic gastrostomy (PEG) tube placement is recommended in amyotrophic lateral sclerosis (ALS) patients with dysphagia to provide reliable access for medications and nutrition. It is preferably done while forced vital capacity (FVC) is greater than 50% of predicted to reduce risk of postprocedural respiratory complications. Percutaneous radiologic gastrostomy has been shown to have higher success rates and lower complication rates compared with PEG. The authors sought to investigate the safety of PEG placement in ALS patients with varying respiratory compromise. The records of 21 patients with ALS who underwent PEG tube placement from October 2010 to October 2013 were retrospectively reviewed to determine rates of successful placement, complication, mortality and survival. PEG was placed successfully in 95.2% of patients. There was 1 major complication, procedure-related death, and failed placement in a patient with FVC 15% predicted who developed procedure-related aspiration and hypoxic respiratory failure and death 8 days after failed PEG attempt. Minor complications included 3 patients with minor pain at insertion site, 1 patient with minor bleeding requiring cauterization and 2 patients requiring PEG tube replacement within 6 months of procedure for accidental dislodgement. After PEG placement, median survival was 327 days (95% confidence interval: 180-687). In conclusion, PEG tube placement in patients with ALS seems to be a safe procedure in patients without significant respiratory compromise. In patients with FVC <50%, based on literature review and the results of this study, the authors recommend percutaneous radiologic gastrostomy over PEG placement.

De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer.

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. To assess the safety and effectiveness of such treatment at a single center. We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. The procedure and devices were well tolerated and mostly effective in our cohort.

CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients.

The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC). This retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients' backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device. During the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7%. The overall mean procedure time was 25.3min. Major AEs occurred in seven patients (4.0%), including bleeding (n=4), colonic injury (n=1), gastric tear (n=1), and aspiration pneumonia (n=1). Minor AEs occurred in 15 patients (8.5%), which included peristomal leakage (n=6), irritation (n=4), inadvertent removal (n=2), peristomal hemorrhage (n=1), peristomal infection (n=1), and wound granulation (n=1). The mean follow-up period was 111days (range 1-1106days). Our study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

Preliminary Results of Percutaneous Radiologic Gastrostomy in a Pediatric Population: A Modified Chiba-Needle Puncture Technique With Single Gastropexy.

The purpose of this study was to evaluate the technical feasibility, safety, and clinical effectiveness of percutaneous radiologic gastrostomy using a modified Chiba-needle puncture technique with single gastropexy in pediatric patients. From July 2006 to December 2013, percutaneous radiologic gastrostomy was performed in 12 children (median age, 21 months; range, 6-46 months). Their stomachs were punctured using a 21-gauge Chiba needle. A single Cope gastrointestinal suture anchor was used for gastropexy, and a tube was inserted through the same tract as the anchor using a 12- or 14-French Dawson-Mueller pigtail drainage catheter. We then evaluated the technical success of the procedure, the number of puncture attempts using a 21-gauge Chiba needle, the procedure time, complications, and treatment of complications. Percutaneous radiologic gastrostomy was technically successful in all patients. Only a single puncture attempt was required in 10 patients (83%); two attempts were needed in two patients (17%). The average procedure time was 10 minutes 25 seconds (range, 5 minutes 5 seconds to 25 minutes 24 seconds). Pneumoperitoneum requiring tube exchange occurred in two of the 12 patients (17%). Two patients experienced pain immediately after the procedure. Three patients who had esophagogastric reflux after percutaneous radiologic gastrostomy underwent conversion percutaneous radiologic gastrojejunostomy. Percutaneous radiologic gastrostomy using a modified Chiba-needle technique with single gastropexy in pediatric patients is technically feasible and safe.

The patient's opinion matters: experience in the nutritional care in an ALS multidisciplinary team

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease which has no cure, so the treatment will be symptomatic in a Multidisciplinary Unit. It is composed of professionals, experts in patient care, with an interdisciplinary vision in order to act in a coordinated manner depending on the different situations which may arise over the course of the disease. There are several studies showing improved survival in patients treated within the framework of a multidisciplinary team compared to treatment by isolated specialties. An ALS Multidisciplinary Unit was created in 2004 in the University Hospital of Bellvitge (HUB). It is composed of a neurologist, pulmonologist, nutritionist, endocrinologist, rehabilitation, physical therapist, psychologist, social worker, nurse manager, speech therapist and an administrative worker. To assess the impact of the multidisciplinary care of our program 418 patients diagnosed with ALS were evaluated, 84 patients who had been treated by general neurology and 334 who had been treated under a model of multidisciplinary care. Patients who were treated in the unit of multidisciplinary care had a median survival of 1246 days (IC 1109-1382), 104 days above the median 1148 days of those followed by a general neurology consultation (CI 998-1297). This difference was statistically significant (log-rank 10,8; p= 0.008). This benefit was independent of having received treatment with riluzole, non-invasive mechanical ventilation or percutaneous gastrostomy. Nutritional assessment was performed on the first visit and all subsequent controls. It is important to do anthropometric measurements and detect unintentional weight loss and its possible precipitating causes in order to establish the appropriate nutritional treatment. The exploration of dysphagia allows a determination of the appropriate dietary advice, the introduction of thickeners to adjust the texture of food or nutritional supplementation with high-calorie formulas to prevent or correct weight loss. If these measures are not sufficient or there is the risk of failure of respiratory function, early gastrostomy placement will be indicated. The analysis of 140 ALS patients (92 controls and 48 with radiologic percutaneous gastrostomy) showed no difference in mean survival time between groups (32 vs 33.9 months, log Rank 1.86 p=0.39). Any patient had major complications. Despite not find changes in survival, the use of gastrostomy should be understood as a treatment to improve the quality of life and well-being of the patient. Psychosocial support of the person and the family environment is essential to integrate all the changes and situations that arise in the course of the disease. This should start from diagnosis as early intervention contributes to improved training, preventing situations of deterioration and helping coping with the dependency process. It is also possible to use technology and social media to complement the classic care model. In the case of the HUB ALS Multidisciplinary Unit, affected individuals and their families have the resources of the Aula Paciente and ALS blog, created with the objective of providing opportunities for dialogue between patients, families and caregivers. The satisfaction degree of the patients with the care provided by the ALS Multidisciplinary Unit on service accessibility, information received and the quality of care was assessed globally as good in 52.8% or very good in 29, 2% of patients. Attention for the ALS affected person must be considered within the framework of a multidisciplinary team made up of all the professionals who go to intervene throughout the disease process in order to provide increased survival with the best care and quality of life.

Sa1489 Outcomes of Endoscopic Versus Radiologic Percutaneous Gastrostomy Tube Placement in Adult Oncology Patients

Gastrostomy tube (G-tube) is used for primary and supplemental feeding as well as for gastric decompression in patients with inoperable bowel obstruction. G-tube placement can be achieved by Percutaneous Endoscopic Gastrostomy (PEG) or Percutaneous Radiologic Gastrostomy (PRG). However, the difference in outcomes between these two methods is not clear in adult oncology patients. Therefore, we investigated the outcomes of endoscopically and fluoroscopically placed G-tubes in oncology patients treated at a national network of oncology hospitals.

A Comparison of Complication Rates Between GI Percutaneous Endoscopic Gastrostomy (PEG) and IR Percutaneous Radiologic Gastrostomy (PRG) Tube Placement

Introduction: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) tube placements are common procedures that are performed by gastroenterologists and interventional radiologists for a variety of patient indications. As with any invasive procedure, the complication rate of PEGs, PRGs, and long-term outcomes become integral when making decisions regarding patient management using this intervention. Despite this, there is very little data on the comparison of the different modalities. To study this, a retrospective, cohort chart review was performed at a single instution. Methods: As a performance improvement project, retrospective data was collected on the indications and complication rates for both PEG placement and PRG placement at Kings County Hospital Center for the past 5 years. A total of 208 PEGs and 186 PRGs were identified. Age, gender, indications, and complication rates were then analyzed using Fisher’s exact t-tailed tests to determine significance. Results: The major results are summarized in Table 1. There was a significant increase in numbers between PRG and GI with regards to PEG replacement (13.5% vs. 26.34% p-value 0.008) and overall death (16.13% vs. 9.13% p-value=0.038). There was an increased trend towards failed placement, but did not reach signficance (2.40% vs. 6.45%, p-value=0.054).Table 1Conclusion: IR-guided PRGs have an increased rate of all cause 6-month mortality and a trend to failed placement, which may be higher considering their signficant amount of PEG replacement procedures over GI. There was no signficant differences in GI bleeding or infection. More analysis needs to be done to determine if this increased complication rate is due to technique versus selection bias such as contraindications to sedation or increased co-morbidities.

Percutaneous radiologic gastrostomy using the one-anchor technique in patients after partial gastrectomy.

ObjectiveThe purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success.Materials and MethodsNineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success.ResultsPercutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011).ConclusionPercutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.

Comparison of Percutaneous Radiologic Gastrostomy by Using Cone Beam CT and Endoscopic Gastrostomy

Comparison of Percutaneous Radiologic Gastrostomy by Using Cone Beam CT and Endoscopic Gastrostomy

Two parallel needles with snare gastropexy device during gastrostomy in children

A ferromagnetic T-fastener is often used in children during gastrostomy procedures. We describe the experience with the use of a new gastropexy device (two parallel needles with a snare) that uses a non-ferromagnetic anchor during primary percutaneous retrograde radiologic gastrostomy insertion in four children with a mean age of 6years and 6months (range: 2years and 11months to 9years and 6months). The new gastropexy device was safe and effective in children. It is advantageous for children requiring magnetic resonance (MR) examinations soon after gastrostomy insertion, especially in view of MR-related implications that result from the use of a ferromagnetic T-fastener.

Image-guided percutaneous gastrostomy using modified large balloon as access target.

To develop a novel percutaneous radiologic gastrostomy using a large-bore, rupture-free, balloon (RFB) catheter in patients with a swallowing disturbance due to a neurological disorder. Consecutive patients underwent percutaneous gastrostomy placement using a balloon catheter with a 5.0-cm 5.0-cm, large-bore, rupture-free balloon on the tip between August 2010 and December 2011. The large balloon in the stomach was percutaneously punctured by the needle, the guide wire was inserted through the abdominal wall, and the push-type gastrostomy tube was finally inserted over the guide wire via the oral cavity. Technical success and complications were evaluated. Fifteen patients (10 men, 5 women; age range, 47-82 years; mean age, 71.7 years) who had cerebral infarction (n=8), intracerebral hemorrhage (n=4), and subarachnoid hemorrhage (n=3) underwent percutaneous radiologic gastrostomy. The procedures were technically successful in all patients. The mean procedure time was 34+- 9 (SD) min (range, 20-47 min). The average follow-up was 158 days (range, 14 - 655 days). No major complications related to the procedure were encountered. Image-guided gastrostomy using a large-bore RFB catheter is an effective method of gastric feeding in patients with swallowing disturbance due to a neurological disorder.

Percutaneous Radiologic Gastrostomy in Patients with Malignant Pharyngoesophageal Obstruction

Percutaneous endoscopic gastrostomy is widely practiced, but we use interventional radiology techniques to perform percutaneous radiologic gastrostomy in cancer patients with conditions that prevent endoscope insertion due to pharyngoesophageal obstruction. This study retrospectively investigated the effectiveness of percutaneous radiologic gastrostomy at our hospital. We investigated the medical records of 105 patients who underwent percutaneous radiologic gastrostomy between 2001 and 2011. The technique used for percutaneous radiologic gastrostomy comprised insufflation to dilate the stomach via a nasogastric tube, followed by fluoroscopically guided puncture and gastrostomy tube placement. In patients for whom a nasogastric tube could not be inserted, the stomach was punctured with a fine needle under ultrasonographic guidance and insufflated via this puncture needle to achieve dilation. Patients comprised 75 men and 30 women (mean age, 63 years). A nasogastric tube was used during percutaneous radiologic gastrostomy in 81 cases, but could not be used in 24. The percutaneous radiologic gastrostomy procedure was successful in all cases. Serious post-percutaneous radiologic gastrostomy complications comprised one case each of decreased hemoglobin requiring blood transfusion, pneumoperitonitis that was treated by a laparotomy and infected fistula requiring tube removal (3/105, 2.9%). Duration of gastrostomy tube placement was 1-731 days, and the outcome was death in 59 cases, hospital transfer in 23, tube removal in 18 and survival with gastrostomy tube in place in 5. Serious complications requiring treatment occurred in 2.9% of cases in which percutaneous radiologic gastrostomy was performed, with mostly good effectiveness. Percutaneous radiologic gastrostomy is feasible even for patients in whom a nasogastric tube cannot be inserted.

Subcutaneous T-Fastener Gastropexy: A New Technique

T-fastener gastropexy is a step in percutaneous radiologic gastrostomy in which the stomach is fastened to the abdominal wall. Minor complications of gastropexy are often related to the prolonged presence of T-fastener sutures. We describe a new technique for gastropexy using absorbable sutures placed subcutaneously, as opposed to the standard percutaneous approach. Subcutaneous gastropexy is safe, obviates follow-up suture removal, and eliminates complications associated with cutaneous sutures.

Radiologic Percutaneous Gastrostomy: Review of Potential Complications and Approach to Managing the Unexpected Outcome

Radiologic percutaneous gastrostomy tube placement is a widely accepted method of enteral access for patients requiring long-term nutritional support for a variety of conditions. Although the safety of this procedure is well documented, complications do occur. The purpose of this article is to review the major and minor complications associated with gastrostomy tube placement and to present appropriate and effective management strategies. Familiarity with the potential complications, techniques for their prevention, and strategies for treatment will help practicing interventional radiologists successfully manage all possible outcomes.

Percutaneous radiological gastrostomy: single-puncture double-anchor technique

We evaluated technical success, safety and effectiveness of percutaneous radiological gastrostomy (PRG) with a modified technique: single puncture and double anchor. From January 2008 to June 2011, 163 patients underwent PRG with a single-puncture double-anchor technique. The stomach was punctured with a 17-gauge Chiba needle, and gastropexy was performed by placing two anchors in the gastric lumen. Finally, a 12-F Wills-Oglesby percutaneous gastrostomy catheter was inserted. Technical success and complications at 30 days were evaluated on the basis of imaging and patients' medical records. PRG was successfully completed in all 163 patients. Only a single puncture was required in all patients. The average PRG procedure time was 9 min. Three patients had major complications: haemorrhage (n=2) and pneumoperitoneum (n=1). Ten patients had minor complications: tube malfunction/breakage (n=9), and leakage through the insertion site (n=1). Two patients died 30 days after the procedure. Single-puncture double-anchor PRG is a fast, safe and effective technique.

Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy

Percutaneous endoscopic gastrostomy is not widely used in malnourished esophageal cancer (EC) patients because of concerns about its feasibility in frequently obstructive tumors, suitability of the stomach as an esophageal substitute, and potential for metastatic inoculation. A percutaneous radiological gastrostomy (PRG) could be an optimal alternative. Experience with PRG among 1,205 consecutive patients presenting with EC from 2002 to 2011 in our department was retrospectively reviewed. PRG was mostly utilized for malnourished patients for whom neoadjuvant chemoradiation was scheduled. The rates of both successful placement and major related complications (Dindo-Clavien ≥III) were analyzed. A matched cohort analysis was constructed in patients who underwent esophagectomy with gastroplasty (n = 688) to evaluate the impact of PRG placement on the suitability of the gastric conduit and on postoperative course. For 78 resected patients with PRG (PRG group), 156 randomly selected controls without PRG (no PRG group) were matched 2:1 for gender, age, ASA grade, clinical TNM stage, and neoadjuvant treatment delivery. PRG placement was planned in 269 (22.3 %) patients mainly with locally advanced EC (63.8 %). PRG placement was feasible in 259 (96.3 %) patients. Sixty-day PRG-related mortality and major morbidity rates were 0 and 3.8 % respectively. For resected patients, the PRG and no PRG groups were comparable regarding perioperative characteristics, except for malnutrition, which was more frequent in the PRG group (P < 0.001). At the time of operation, PRG takedown and site closure were uncomplicated and the use of the stomach was possible in all 78 patients. Despite a higher malnutrition rate at presentation in the PRG group, rates of overall morbidity, and morbidity related to esophageal surgery, were similar between the two groups (P > 0.258). PRG is feasible, safe, and useful in nonselected patients with EC and does not compromise the suitability of the stomach as an esophageal substitute in patients deemed to be resectable.

PTU-182 Percutaneous radiological gastrostomy in oesophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy

IntroductionPercutaneous endoscopic gastrostomy is not widely used in malnourished oesophageal cancer (OC) patients because of concerns about feasibility in frequently obstructive tumours, suitability of the stomach as an oesophageal substitute,...

Percutaneous Gastrostomy Tube Placement Using a Balloon Catheter in Patients With Head and Neck Cancer

Patients with head and neck cancer frequently require gastrostomy feeding. The aim of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance in patients with head and neck cancer with swallowing disturbance or trismus. Percutaneous CT and fluoroscopic gastrostomy placement of push-type gastrostomy tubes using a RFB catheter was performed in consecutive patients with head and neck cancer between April 2007 and July 2010. The technical success, procedure duration, and major or minor complications were evaluated. Twenty-one patients (14 men, 7 women; age range, 55-78 years; mean age, 69.3 years) underwent gastrostomy tube placement. The tumor location was the pharynx (n = 8), oral cavity (n = 7), and gingiva (n = 6). Gastrostomy was performed in 15 patients during treatment and 6 patients after treatment. Percutaneous radiologic gastrostomy was technically successful in all patients. The median procedure time was 35 ± 19 (interquartile range) minutes (range, 25-75). The average follow-up time interval was 221 days (range, 10-920 days). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up periods. Percutaneous CT and fluoroscopic-guided gastrostomy with push-type tubes using a RFB catheter is a relatively safe and effective means of gastric feeding, with high success and low complication rates in patients with head and neck cancer in whom endoscopy was not feasible.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

ObjectiveUpper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE).Materials and MethodsWe retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG.ResultsThe initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE.ConclusionWe observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.