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. 2024 Feb 20;7(1):20.
doi: 10.1186/s42155-024-00432-y.

Ultrasound (US)-guided percutaneous thrombin injection for stoma-site bleeding after PEG tube insertion: a case series and review of the literature

Aws Alfahad  1 , Rawan Alhalabi  2
Affiliations

Ultrasound (US)-guided percutaneous thrombin injection for stoma-site bleeding after PEG tube insertion: a case series and review of the literature

Aws Alfahad et al. CVIR Endovasc. .

Abstract

Background: Post-gastrostomy bleeding sequelae are acknowledged, with reported approaches focusing on conservative measures or surgical repair. Nonetheless, Percutaneous Thrombin Injections (PTI) role in PEG-site-related bleeding remains underexplored. PTI under ultrasound guidance is an advocated management strategy for stoma-site bleeding following gastrostomy in high-risk patients, particularly those on direct oral anticoagulants.

Case presentation: This study presents three cases with multiple comorbidities who underwent PTI. Resulting in immediate resolution of bleeding, no systemic\local effect, and no reported complications or rebleeding after a 3-6-month follow-up.

Conclusion: The findings highlight the safety, direct complete resolution, and absence of sequelae associated with PTI, suggesting its potential as a promising technique in managing PEG stoma-related bleeding.

Keywords: Anticoagulants; GI bleeding; Interventional radiology; Percutaneous Thrombin Injections PTI; Thrombin; Ultrasound.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Illustration of PTI technique
Fig. 2
Fig. 2
Fluoroscopy image demonstrating the needle site
Fig. 3
Fig. 3
A non-enhanced CT scan of the PEG tube three days post-enjection, showcasing a patent ballon (green circle), a clear stomach wall devoid of necrosis or hematoma, and an absence of any bleeding (red arrow)
Fig. 4
Fig. 4
US post PTI revealing patent PEG balloon and no hemorrhage
See this image and copyright information in PMC

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