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BackTable / VI / Podcast / Episode #321

New Innovations in Lower GI Bleed Embolization

with Dr. Kevin Henseler

In this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Kevin Henseler discuss his treatment algorithm and new technologies for embolization of GI bleeds.

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Boston Scientific Obsidio Embolic

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New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler on the BackTable VI Podcast)
Ep 321 New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler
00:00 / 01:04

BackTable, LLC (Producer). (2023, May 12). Ep. 321 – New Innovations in Lower GI Bleed Embolization [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Kevin Henseler discusses New Innovations in Lower GI Bleed Embolization on the BackTable 321 Podcast

Dr. Kevin Henseler

Dr. Kevin Henseler is an interventional radiologist with Midwest Radiology in St. Paul, Minnesota.

Dr. Aaron Fritts discusses New Innovations in Lower GI Bleed Embolization on the BackTable 321 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.

Synopsis

Dr. Henseler starts by differentiating between lower and upper GI bleeds. Upper GI bleeds tend to be more life-threatening and are most commonly caused by esophageal varices or duodenal ulcers, and many of these consults come from the endoscopy suite. These upper GI bleeds also have a higher risk of recurrence. On the other hand, lower GI bleeds can be more indolent. CTA is the most efficient way to assess the source of GI bleeding. It provides valuable information about the vascular territory, including localization of bleeding, planning where to inject during angiography, and variant anatomy. If CTA is negative for bleeding, Dr. Henseler does not move onto angiography. He monitors the patient for further signs of intermittent bleeding and may re-image or intervene the following day.

If CTA does show bleeding, Dr. Henseler moves onto angiography and embolization. He finds that there are few contraindications to angiography. Relative contraindications include renal insufficiency, which is a small tradeoff for a lifesaving procedure, and contrast allergy, which can be addressed with a preprocedural steroid dose.

When it comes to methods of embolization, detachable coils have been a mainstay. While they are more expensive than pushable coils, detachable coils allow for more exact placement and increased safety and more IRs are being trained to use these now. Dr. Henseler also discusses the use of embolic particles, which carry risks of end-organ damage and ischemia, as well as embolic glue, which can be difficult to use if the operator does not have sufficient training. Then, we shift gears to discuss Obsidio, a new injectable solid that is soon to be commercially available. It exists as a liquid when it is in its pressurized form within the microcatheter; however, it immediately solidifies in the vessel as soon as the injection ceases. Obsidio is made of radio-opaque tantalum so it is visible on CT, stays permanently in the vessel, and can be used in conjunction with coils if desired. Additionally, its cohesive properties decrease the risk of abdominal extravasation and it can be used with any catheter.

Resources

Transcript Preview

[Dr. Kevin Henseler]
I think another thing that trainees can always remember is glucagon is your friend, if especially big GI bleeds, there often is hypermobility of the bowel. If you need to give a little bit of glucagon, I think that's just as helpful as trying to do breath holds and then you've got that bowel at least reasonably hexed in place for a few minutes as you're doing some runs.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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