# Transcatheter Arterial Embolization for Bleeding Caused by Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Case Series

## TL;DR

This case series shows that transcatheter arterial embolization effectively stops severe bleeding after a specific endoscopic procedure.

## Contribution

The study presents real-world evidence of TAE's effectiveness for rare but severe bleeding after EUS-FNA.

## Key findings

- TAE achieved 100% technical and clinical success in six patients with EUS-FNA-induced bleeding.
- Angiography identified extravasation or pseudoaneurysms in five of six patients.
- Only one minor complication (duodenal ulcer) occurred and was managed without surgery.

## Abstract

Introduction

Bleeding is the most frequent complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In a few cases of massive bleeding caused by EUS-FNA, transcatheter arterial embolization (TAE) has been used to obtain hemostasis. We present a case series of patients who underwent TAE for bleeding due to EUS-FNA.

Methods

This case series included six patients (five men and one woman) who underwent TAE for bleeding caused by EUS-FNA between January 2018 and December 2022 at the four institutions involved in this study. The median age at TAE was 72.5 years (range, 67-83 years). The target sites for EUS-FNA were the pancreatic tail (n = 3), pancreatic head (n = 2), and hepatic hilar lymph nodes (n = 1). The angiographic findings, embolization procedures, technical and clinical success rates, and TAE complications were retrospectively assessed.

Results

Angiography revealed contrast-media extravasation or pseudoaneurysms in five patients. In all patients, TAE using a microcatheter was performed via the transfemoral approach. N-butyl cyanoacrylate, coils, and gelatin sponges were used for embolization. The technical and clinical success rates of TAE were 100%. One complication, a duodenal ulcer, developed in one patient and was managed conservatively.

Conclusion

TAE is an effective and safe treatment for EUS-FNA-induced bleeding.