Superselective Gelfoam Blind Embolization of Arterial Hemorrhage Caused by Esophageal Neoplasia

Bleeding is a common symptom of esophageal neoplasm; endoscopic therapy remains the initial choice of treatment. Due to too huge size, massive bleeding or intoleration of the patient, endoscopic therapy fails to control the esophageal tumor bleeding; thus, many treatment methods have been investigated. Among different treatment methods, transcatheter arterial embolization (TAE) is proven clinically promising. However, not only we lack adequate experience of esophageal artery embolization, but also we don’t absolutely understand its role and mechanism, TAE is rarely used for the treatment of esophageal cancer bleeding. Here, we present a case of severe esophageal cancer bleeding refractory to endoscopic therapy that was successfully managed with blind TAE using gelfoam slurry. No complication associated with this method was observed. We also review previous literatures. Correspondence Author to: Kar-Wai Lui Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan No. 5, Fu-Hsing Street, Kuei-Shan, Taoyuan 333, Taiwan J Radiol Sci 2012; 37: 185-189 Superselective gelfoam blind embolization of arterial hemorrhage caused by esophageal neoplasia 186 J Radiol Sci December 2012 Vol.37 No.4 Panendoscopy (PES) identified a very large necrotic mass with active oozing in the lower third of the thoracic esophagus. A tissue biopsy confirmed sarcomatoid carcinoma. For tumor staging, thoracic computed tomography (Fig. 1) and esophagography were performed, revealing a mass in the distal third of the thoracic esophagus with celiac nodal metastasis. During hospitalization, after Port-A catheter implantation and jejunostomy, tarry stool was observed with severe anemia (hemoglobin 9.2 g/dL), followed by emesis. Despite transfusion of 8 U packed red blood cells and medication, the patient’s hemodynamic status remained unstable. Emergency PES identified a prominent bleeding tumor in esophagus, but the exact source of the hemorrhage could not be found. Angiography was thus performed. A 5-F angiosheath was inserted into the right femoral artery. An aortogram obtained with a 4-F catheter (J-curve; Terumo Corporation, Tokyo, Japan) demonstrated a hypervascular tumor in the mediastinum receiving blood supply from a