Endovascular Hemostasis in the Management of Arterial Upper Gastrointestinal Bleeding: Literature Review

Arterial upper gastrointestinal bleeding (UGIB) remains a major clinical challenge due to high rates of rebleeding even after technically successful endoscopic hemostasis. A systematic analysis of 60 contemporary publications shows that transcatheter arterial embolization (TAE) has evolved from a rescue intervention into an integral component of multidisciplinary strategies aimed at achieving durable hemostasis. Indications and contraindications for endovascular treatment are summarized, and an algorithm for embolic agent selection is proposed based on vessel caliber, anatomic variability, and pathologic remodeling of the celiac and mesenteric arterial systems. Prophylactic embolization in patients who achieve primary endoscopic hemostasis but meet high-risk criteria for rebleeding significantly reduces recurrent hemorrhage and in-hospital mortality compared with endoscopic therapy alone. In cases of refractory bleeding, TAE demonstrates high clinical efficacy and offers an organ-preserving alternative to surgery, particularly in patients with elevated operative risk. The accumulated evidence supports the incorporation of preventive embolization into clinical protocols for this patient population.

1. Barkun A.N., Laine L., Leontiadis G.I., Gralnek I.M., Carman N., Ibrahim M., et al. Canadian Association of Gastroenterology Clinical Practice Guideline for the endoscopic management of nonvariceal nonpeptic ulcer upper gastrointestinal bleeding. Gastroenterology. 2025;169(5):863–91. DOI: 10.1053/j.gastro.2025.04.041

2. Yu Q., Funaki B., Ahmed O. Twenty years of embolization for acute lower gastrointestinal bleeding: a meta-analysis of rebleeding and ischaemia rates. Br J Radiol. 2024;97(1157):920–32. DOI: 10.1093/bjr/tqae037

3. Scherdin Y., Halldestam I., Redeen S. Incidence and mortality related to gastrointestinal bleeding, and the effect of tranexamic acid on gastrointestinal bleeding. Gastroenterology Res. 2021;14(3):165–72. DOI: 10.14740/gr1383

4. Kokov L.S., Gezalov F.F., Yartsev P.A., Tveritneva L.F. Modern methods of treatment of patients with gastric cancer complicated by bleeding (literature review). Herald of surgical gastroenterology. 2022;2:17–24 (In Russ.).

5. Shchegolev A.A., Al Sabunchi O.A., Meleshko Yu.B., Kiseleva A.S., Khachaturov M.Yu. Proton pump inhibitors in the treatment of gastroduodenal ulcer bleeding: optimization of drug therapy methods. Experimental and Clinical Gastroenterology. 2022;7:110– 4 (In Russ.). DOI: 10.31146/1682-8658-ecg-203-7-110-114

6. Mekheal N., Roman S., Alkomos M.F., Mekheal E., Farokhian A., Millet C., et al. Hemosuccus pancreaticus: challenging diagnosis and treatment. Eur J Case Rep Intern Med. 2022;9(5):003337. DOI: 10.12890/2022_003337

7. Ivashkin V.Т., Mayev I.V., Tsarkov Р.V., Korolev М.Р., Andreev D.N., Baranskaya Е.К., et al. Diagnostics and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, the Russian Society of Colorectal Surgeons, the Russian Endoscopic Society and the Scientific Society for the Clinical Study of Human Microbiome). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(2):101–31 (In Russ.). DOI: 10.22416/1382-4376-2024-34-2-101-131

8. Laine L., Barkun A.N., Saltzman J.R., Martel M., Leontiadis G.I. ACG Clinical Guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116(5):899–917. DOI: 10.14309/ajg.0000000000001245

9. Cherednikov E.F., Barannikov S.V., Banin I.N., Maleev Yu.V., Leontiev A.V., Bavykina I.A. Personalized management for upper gastrointestinal bleeding. Russian Journal of Evidence-Based Gastroenterology. 2022;11(3):5–10 (In Russ.). DOI: 10.17116/dokgastro2022110315

10. Kim J.S., Kim B.W., Kim D.H., Park C.H., Lee H., Joo M.K., et al. Guidelines for nonvariceal upper gastrointestinal bleeding. Gut Liver. 2020;14(5):560–70. DOI: 10.5009/gnl20154

11. Sung J.J., Chiu P.W., Chan F.K.L., Lau J.Y., Goh K.L., Ho L.H., et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67(10):1757–68. DOI: 10.1136/gutjnl-2018-316276

12. Sazhin V.P., Beburishvili A.G., Panin S.I., Sazhin I.V., Postolov M.P. Influence of the incidence of ulcerative gastroduodenal bleeding on the effectiveness of treatment. Statistical surveillance. Pirogov Russian Journal of Surgery. 2021;1:27–33 (In Russ., In Engl.). DOI: 10.17116/hirurgia202101127

13. Sazhin V.P., Fedorov A.V., Panin S.I., Sazhin I.V., Yudin V.A., Podyablonskaya I.A., et al. Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation. Pirogov Russian Journal of Surgery. 2023;9:5–12 (In Russ.). DOI: 10.17116/hirurgia20230915

14. Revishvili A.Sh., Fedorov A.V., Sazhin V.P., Oloviannyĭ V.E. Emergency surgery in Russian Federation. Pirogov Russian Journal of Surgery. 2019;3:88–97 (In Russ.). DOI: 10.17116/hirurgia201903188

15. Gezalov F.F., Tveritneva L.F., Yartsev P.A., Lebedev A.G., Teterin Y.S., Tsuleiskiri B.T. Surgical tactics at gastrointestinal bleeding and an unsuccessful attempt by means of endoscopic hemostasis. Herald of surgical gastroenterology. 2020;4:3–11 (In Russ.).

16. Totikov Z.V., Totikov V Z., Chubetsova R A., Kaziev T.T., Logvina L.L. Modern and promising methods of endoscopic hemostasis in patients with non-variceal bleeding. Sovremennaâ nauka: aktual’nye problemy teorii i praktiki. Seriâ Estestvennye i tehničeskie nauki. 2022;(4-2):224–31 (In Russ.). DOI: 10.37882/2223-2966.2022.04-2.34

17. Kubyshkin V.A., Sazhin V.P., Fedorov A.V., Krivtsov G.A., Sazhin I.V. Organization and results of surgical care for ulcerative gastroduodenal bleeding in the hospitals of Central Federal District. Pirogov Russian Journal of Surgery. 2017;2:4–9 (In Russ.). DOI: 10.17116/hirurgia201724-9

18. Obeidat M., Teutsch B., Rancz A., Tari E., Márta K., Veres D.S., et al. One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability: A systematic review and meta-analysis. World J Gastroenterol. 2023;29(28):4466–80. DOI: 10.3748/wjg.v29.i28.4466

19. Kaminskis A., Ivanova P., Kratovska A., Ponomarjova S., Ptašņuka M., Demičevs J., et al. Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience. World J Emerg Surg, 2019;14:45. DOI: 10.1186/s13017-019-0264-z

20. Mille M., Huber J., Wlasak R., Engelhardt T., Hillner Y., Kriechling H., et al. Prophylactic transcatheter arterial embolization after successful endoscopic hemostasis in the management of bleeding duodenal ulcer. J Clin Gastroenterol. 2015;49(9):738–45. DOI: 10.1097/MCG.0000000000000259

21. Sotiropoulos C., Papantoniou K., Tsounis E., Diamantopoulou G., Konstantakis C., Theocharis G., et al. Acute upper gastrointestinal bleeding: less severe bleeding in more frail and older patients, comparison between two time periods fifteen years apart. Gastroenterology Res. 2022;15(3):127–35. DOI: 10.14740/gr1534

22. Luomajoki J., Mattila L., Laukkarinen J., Ukkonen M. Long-term outcomes following acute upper gastrointestinal bleeding remain poor: a single-center comparison over two distinct time periods within the last 15 years in Finland. Visc Med. 2024;40(1):30–8. DOI: 10.1159/000535061

23. Mille M., Engelhardt T., Stier A. Bleeding duodenal ulcer: strategies in high-risk ulcers. Visc Med. 2021;37(1):52–62. DOI: 10.1159/000513689

24. Loffroy R., Guillen K., Chevallier O. Re: Systematic review and meta-analysis of prophylactic transarterial embolization for high-risk bleeding peptic ulcer disease. J Vasc Interv Radiol. 2021;32(9):1389–90. DOI: 10.1016/j.jvir.2021.04.031

25. Yartsev P.A., Kokov L.S., Tveritneva L.F., Kirushenkov V.P., Kuprieva M.V., Teterin Y.S., et al. Place of endovascular embolization in the complex of hemostasis methods for gastroduodenal bleeding. Herald of surgical gastroenterology. 2021;2:22–9 (In Russ.).

26. Matsumoto T., Yoshimatsu R., Shibata J., Osaki M., Maeda H., Miyatake K., et al. Transcatheter arterial embolization of nonvariceal gastrointestinal bleeding with n-butyl cyanoacrylate or coils: a systematic review and meta-analysis. Sci Rep. 2024;14(1):27377. DOI: 10.1038/s41598-024-79133-4

27. Ini’ C., Distefano G., Sanfilippo F., Castiglione D.G., Falsaperla D., Giurazza F., et al. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc. 2023;6(1):18. DOI: 10.1186/s42155-023-00360-3

28. Hosse C., Moos M., Becker L.S., Sieren M., Müller L. Trans-arterial embolization for treatment of acute lower gastrointestinal bleeding-a multicenter analysis. Eur Radiol. 2025;35(5):2746–54. DOI: 10.1007/s00330-024-11102-x

29. Yu Q., Liu C., Collura B., Navuluri R., Patel M., Yu Z., et al. Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: a meta-analysis. World J Emerg Surg. 2021;16(1):29. DOI: 10.1186/s13017-021-00371-2

30. Zetner D., Rasmussen I.R., Frykman C.P., Jensen L.R., Jensen R.J., Possfelt-Møller E., et al. Risk factors for rebleeding and mortality following prophylactic transarterial embolization for patients with high-risk peptic ulcer bleeding: a single-center retrospective cohort study. Surg Endosc. 2024;38(4):2010–8. DOI: 10.1007/s00464-024-10709-x

31. Yamane M., Ishikawa Y., Asano D., Watanabe S., Ueda H., Akahoshi K., et al. Surgical anatomy of the dorsal pancreatic artery: Considering embryonic development. Pancreatology. 2023;23(6):697–703. DOI: 10.1016/j.pan.2023.07.009

32. Nakayama K., Shimohira M., Nagai K., Ohta K., Kawai T., Sawada Y., et al. Duodenal stenosis after transcatheter arterial embolization for rupture of an inferior pancreaticoduodenal aneurysm. Radiol Case Rep. 2021;16:2869–72. DOI: 10.1016/j.radcr.2021.06.090

33. Khitaryan A.G., Bondarenko I.V., Andreev E.V., Bondarenko V.A., Khitaryan V.A., Nazikyan R.A. Place for arteriae embolization in patients with recurrent gastrointestinal bleeding in case of ulcer. Russian Journal of Operative Surgery and Clinical Anatomy. 2023;7(1):23–33 (In Russ.). DOI: 10.17116/operhirurg2023701123

34. Thiry G.J.H., Dhand S., Gregorian A., Shah N. Provocative mesenteric angiography: outcomes and standardized protocol for management of recurrent lower gastrointestinal hemorrhage. J Gastrointest Surg. 2022;26(3):652–4. DOI: 10.1007/s11605-021-05131-w

35. Foltz G., Khaddash T. Embolization of nonvariceal upper gastrointestinal hemorrhage complicated by bowel ischemia. Semin Intervent Radiol, 2019;36(2):76–83. DOI: 10.1055/s-0039-1688419

36. Orron D.E., Bloom A.I., Neeman Z. The role of transcatheter arterial embolization in the management of nonvariceal upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2018;28(3):331–49. DOI: 10.1016/j.giec.2018.02.006

37. Starodubov O.D., Kovalenko I.B., Polyaev Yu.A., Garbuzov R.V., Kapranov M.S., Myl’nikov A.A., et al. Staged embolization of AVMS of the scapular and axillary regions (case report). Diagnostic and Interventional Radiology. 2023;17(S2.1):49–58 (In Russ.). DOI: 10.25512/DIR.2023.17.2(1).05

38. Loffroy R., Falvo N., Nakai M., Pescatori L., Midulla M., Chevallier O. When all else fails — Radiological management of severe gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2019;42–43:101612. DOI: 10.1016/j.bpg.2019.04.005

39. Vorčák M., Sýkora J., Ďuríček M., Bánovčin P., Grendár M., Zeleňák K. Endovascular treatment of gastrointestinal hemorrhage. Medicina. 2022;58(3):424. DOI: 10.3390/medicina58030424

40. Yoon J.T., Kwon B., Choi J.H., Hwang S.M., Kim M., Hwang S., et al. In vitro head-to-head comparison of flow reduction between fibered and non-fibered pushable coils. Neurointervention. 2024;19(1):31–8. DOI: 10.5469/neuroint.2024.00031

41. Xiao N., Lewandowski R.J. Embolic agents: coils. Semin Intervent Radiol. 2022;39(1):113–8. DOI: 10.1055/s-0041-1740939

42. Loffroy R., Desmyttere A.S., Mouillot T., Pellegrinelli J., Facy O., Drouilllard A., et al. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur Radiol. 2021;31(5):3015–26. DOI: 10.1007/s00330-020-07427-y

43. Loffroy R., Comby P.O., Falvo N., Pescatori L., Nakaï M., Midulla M., et al. Transcatheter arterial embolization versus surgery for uncontrolled peptic ulcer bleeding: game is over. Quant Imaging Med Surg. 2019;9(2):144–5. DOI: 10.21037/qims.2019.02.01

44. Kokov L.S. (ed.) Therapeutic endovascular occlusion: Scientific-practical guide. Moscow: Russian Academy of Sciences; 2025 (In Russ.).

45. Hu J., Albadawi H., Chong B.W., Deipolyi A.R., Sheth R.A., Khademhosseini A., et al. Advances in biomaterials and technologies for vascular embolization. Adv Mater. 2019;31(33):e1901071. DOI: 10.1002/adma.201901071

46. Pal A., Blanzy J., Gómez K.J.R., Preul M.C., Vernon B.L. Liquid embolic agents for endovascular embolization: a review. Gels. 2023;9(5):378. DOI: 10.3390/gels9050378

47. Lewis A.L., Caine M., Garcia P., Ashrafi K., Tang Y., Hinchcliffe L., et al. Handling and performance characteristics of a new small caliber radiopaque embolic microsphere. J Biomed Mater Res B Appl Biomater. 2020;108(7):2878–88. DOI: 10.1002/jbm.b.34619

48. Vairavamurthy J., Yuan F., Anders R.A., Kraitchman D.L., Weiss C.R. Identifying the ideal target vessel size for bariatric embolization: histologic analysis of swine and human gastric fundi. J Vasc Interv Radiol. 2022;33(1):28–32. DOI: 10.1016/j.jvir.2021.09.018

49. Vollherbst D.F., Chapot R., Bendszus M., Möhlenbruch M.A. Glue, Onyx, Squid or PHIL? Liquid embolic agents for the embolization of cerebral arteriovenous malformations and dural arteriovenous fistulas. Clin Neuroradiol. 2022;32(1):25-38. DOI: 10.1007/s00062-021-01066-6

50. Schmitt N., Wucherpfennig L., Hohenstatt S., Karimian-Jazi K., Breckwoldt M.O., Kauczor H.U., et al. Material-specific roadmap modes can improve the visibility of liquid embolic agents for endovascular embolization: a systematic in vitro study. AJNR Am J Neuroradiol. 2022;43(12):1749–55. DOI: 10.3174/ajnr.A7706

51. Kohlbrenner R., Fidelman N., Kohi M.P., Kumar V., Kolli K.P. Onyx embolization of an enlarging arterioportal pancreatic AVM using a balloon-occlusion microcatheter. Diagn Interv Radiol. 2021;27(3):458–9. DOI: 10.5152/dir.2020.20416

52. Khan S., Khan M.A., Jadoon A.K., Khan A., Khan D.A., Gohar M., et al. Comparison of prophylactic transcatheter arterial embolization and standard therapy in high-risk non-variceal upper gastrointestinal bleeding: a meta-analysis. Gastroenterology Res. 2025;18(3):139–48. DOI: 10.14740/gr2041

53. Boros E., Sipos Z., Hegyi P., Teutsch B., Frim L., Váncsa S., et al. Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis. World J Gastroenterol. 2021;27(40):6985–99. DOI: 10.3748/wjg.v27.i40.6985

54. Lebedev N.V., Belozerov G.E., Klimov A.E., Sokolova P.Iu., Spasskiy A.A., Barkhudarov A.A. Transcatheter embolization in prevention of recurrent bleeding from stomach ulcers. Pirogov Russian Journal of Surgery. 2017;5:31–5 (In Russ.). DOI: 10.17116/hirurgia2017531-35

55. Romstad K.K., Detlie T.E., Søberg T., Thomas O., Ricanek P., Jahnsen M.E., et al. Treatment and outcome of gastrointestinal bleeding due to peptic ulcers and erosions — (BLUE study). Scand J Gastroenterol. 2022;57(1):8–15. DOI: 10.1080/00365521.2021.1988701

56. Tarasconi A., Baiocchi G.L., Pattonieri V., Perrone G., Abongwa H.K., Molfino S., et al. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg, 2019;14:3. DOI: 10.1186/s13017-019-0223-8

57. Kozai L., Tan A., Nebrejas K., Nishimura Y. Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2025;37(2):161–6. DOI: 10.1097/MEG.0000000000002867

58. Otdelnov L.A., Mastyukova A.M., Ptushko S.S. Review of objective scales for predicting recurrent gastrointestinal bleeding. Medicinskij alʹmanah. 2022;4(73):14–26 (In Russ.).

59. Alekyan B. G., Grigor’yan A.M., Staferov A.V. X-ray endovascular diagnostics and treatment of cardiovascular diseases in the Russian Federation. Endovaskulyarnaya hirurgiya. 2023;10:5–256 (In Russ.).

60. Repin I.G., Brekhov E.I., Kalinnikov V.V., Sychev A.V., Repin D.I., Shuleshova A.G. Diagnosis and treatment of acute nonvariceal gastroduodenal bleeding. Мoscow, 2025 (In Russ.).