Immediate control of acute intracystic arterial hemorrhage

Vinay Dhir, MD, from the Baldota Institute of Digestive Sciences, Global Hospitals, in Mumbai, India presents this VideoGIE case, “Immediate control of acute intracystic arterial hemorrhage after EUS-FNA by EUS-guided fine-needle injection.”

This video describes stopping of intra-arterial bleeding following EUS-guided cyst aspiration by utilizing EUS-guided FNA (EUS-FNA). This 60-year-old patient was referred to us for evaluation of a cystic lesion in the head of the pancreas. EUS showed a 4.5 x 4 cm cystic lesion in the head of pancreas. After Doppler examination, we performed EUS-guided aspiration of the cyst with a 22 gauge needle. Following cyst aspiration, as we withdrew the needle, we saw the cyst filling with a hyper-echoic haze. Doppler examination identified an arterial bleed from a vessel in the cyst wall. The bleeding did not stop for about 5 minutes. We then injected 1:10000 adrenaline to the site of the bleeding. This resulted in stoppage of bleeding. Although the bleeding did not appear to be life threatening, it did continue for some time despite applying pressure with the scope tip.

The video shows a simple method of stopping bleeding following EUS-FNA/aspiration.

It is important to be vigilant for bleeding following EUS-FNA/aspiration. If the cyst starts filling with a hyperechoic haze, Doppler examination should be done to locate the culprit vessel. Injection of adrenaline at the site of bleeding vessel should stop the bleeding immediately.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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