Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Refractory Upper Gastrointestinal Bleeding: A Case Series.

While resuscitative endovascular balloon occlusion of the aorta (REBOA) is a recognized life-saving intervention for hemorrhagic control in trauma, evidence supporting its use in managing refractory upper gastrointestinal bleeding (UGIB) is still limited. However, REBOA holds considerable potential for providing crucial hemodynamic stabilization in refractory UGIB cases where conventional therapies fail to achieve adequate hemostasis. We present cases of three elderly patients (88F, 72M, 74M) with refractory UGIB and profound hemorrhagic shock unresponsive to initial resuscitation. REBOA was emergently deployed at the bedside in the intensive care unit (ICU) using anatomical landmarks and ultrasound guidance, achieving rapid circulatory stabilization and enabling subsequent definitive hemostasis by surgical or endoscopic methods. No REBOA-related complications such as organ dysfunction or ischemia were observed. Our experience suggests REBOA may serve as a safe and effective bridge to hemostasis in select patients with refractory UGIB, even when deployed in an ICU setting without angiography. Further research is needed to establish standardized protocols and define optimal patient selection.