Effectiveness of Coil Embolization in Angiographically Detectable versus Non-detectable Sources of Upper Gastrointestinal Hemorrhage

Letter Reply Re: “Endoscopy-Guided Empiric Arterial Embolization for Angiographically Negative Upper Gastrointestinal Bleeding: Use it Without Fear!”

“…We agree with the comment that the rate of active bleeding at angiography in our study was low at 32.5 % comparable to some studies [2,3]. However, our figure is similar to a study by Padia et al [4] where approximately 33% of patients showed active contrast extravasation during angiography. In our study, a majority of the patients who underwent empiric embolization had prior endoscopy (82 %, 14/17) with either refractory or failed attempted endoscopic treatment.…”

“…This may have increased the number of positive cases; however, in the few cases for which we have used them, we did not find them particularly useful. There is increasing evidence for using empiric GDA embolization [1][2][3][4]6]. The literature has demonstrated that provocative angiography has been useful and safe in lower gastrointestinal hemorrhage [6], but there is little evidence for its use in UGIB.…”

Upper Gastrointestinal Bleeding in Oncological Patients

“…Sometimes there is only indirect evidence of bleeding in an angiography (early draining vessels, neovascularity, arteriovenous fistulas, and the filling of spaces outside the bowel). Treatment with empiric embolization can be performed in these cases (embolization of a vessel thought to be supplying the bleeding source without bleeding having been demonstrated in the angiography).Empiric embolization is as effective as in those patients who show contrast extravasation during angiography [36].…”

Transcatheter Intervention for Non-variceal Gastrointestinal Bleeding: What Have We Learned in 45 Years?

“…In suspected UGI bleeding, endoscopy should be the primary study for diagnosis and potential treatment. When bleeding is refractory to endoscopic treatment or recurs after treatment, mesenteric angiography with targeted or empiric embolization can be pursued with high technical success, good efficacy, and low complication rate, as demonstrated in the current study and by others [6][7][8]. For those patients who fail these initial measures, repeat procedures and/or surgery may be necessary.…”

“…In the past several years, numerous studies, predominantly retrospective series, have reported the safety and efficacy of arterial embolization for UGI and LGI bleeding [5][6][7]. Although published algorithms for the management of GI bleeding exist, the application of mesenteric angiography with transcatheter arterial embolization in the therapy of GI hemorrhage remains controversial.…”