Reappraising the role of angiography in managing intraluminal postpancreatoduodenectomy hemorrhage: Analysis of 115 cases from 3,011 consecutive pancreatoduodenectomies.

Abstract

Intraluminal postpancreatoduodenectomy hemorrhage is an uncommon but potentially devastating complication, with clinically complex and multifactorial sources. Current evidence on optimal management, particularly the role of angiography, remains controversial. This study aimed to optimize the management strategies for intraluminal postpancreatoduodenectomy hemorrhage by analyzing data from a high-volume center. This single-center, retrospective study studied consecutive patients who underwent pancreatoduodenectomy from July 2018 to June 2025. The clinical manifestations, management, and outcomes of intraluminal postpancreatoduodenectomy hemorrhage were analyzed. Among the 3,011 patients who underwent pancreatoduodenectomy, intraluminal postpancreatoduodenectomy hemorrhage was observed in 115 patients (3.8%). The overall mortality of intraluminal postpancreatoduodenectomy hemorrhage patients was 6.1%. The bleeding sources were identified in 63 patients (54.8%), among whom 33 (28.7%) were diagnosed as "false" intraluminal postpancreatoduodenectomy hemorrhage because of primary extraluminal hemorrhage. Multivariate analyses suggested that high body mass index (odds ratio, 1.30; 95% confidence interval, 1.06-1.58; P = .010) was an independent risk factor for "false" intraluminal postpancreatoduodenectomy hemorrhage. Angiography demonstrated superior localization of bleeding sources (65.3%) compared with endoscopy (32.7%) and computed tomography (26.1%) (P < .001), with a lower false-positive rate than relaparotomy (2.0% vs 17.5%, P = .030). Definitive hemostasis rate was comparable between angiography (44.9%) and relaparotomy (50.0%), both significantly outperforming endoscopy (21.2%, P = .008). "False" intraluminal postpancreatoduodenectomy hemorrhage represents a significant subset of intraluminal postpancreatoduodenectomy hemorrhage cases. Angiography may serve as a reliable tool for both the diagnosis and treatment of intraluminal postpancreatoduodenectomy hemorrhage, particularly when "false" intraluminal postpancreatoduodenectomy hemorrhage is highly suspected.