Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis

Chevallier, Olivier; Comby, Pierre-Olivier; Guillen, Kévin; Pellegrinelli, Julie; Mouillot, Thomas; Falvo, Nicolas; Bardou, Marc; Midulla, Marco; Aho-Glélé, Serge; Loffroy, Romaric

doi:10.1016/j.diii.2021.03.004

Cited by 32 publications

(13 citation statements)

References 55 publications

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“…The most common complication was the development of bowel infarction or development of an ulcer (114). In another systematic review and meta-analysis of 243 patients with LGIB undergoing TA with NBCA embolization, the technical success rate was 98.8%; however, 30-day rebleeding and mortality rate were 15.7% and 12.7%, respectively (115). Role of colonoscopy after a positive CTA.…”

Section: Management Of a Positive Ctamentioning

confidence: 99%

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

et al. 2022

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Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.

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Section: Management Of a Positive Ctamentioning

confidence: 99%

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

et al. 2022

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“…Recurrency of hemorrhage after TE with coils or gelfoam has showed, in recent publications, consistent rates at 30 days ranging from 23% to 27.8% for gastrointestinal bleeding and 20.8% for peripheral acute arterial bleeding (Yap et al 2013 , Sirvinskas et al 2017 , Beggs et al 2014 , Powerski et al 2018 ). In comparison to traditional embolic agents, embolization with NBCA for non-variceal gastrointestinal bleeding has been associated with lower rebleeding rates, of, respectively, 12.5% and 15.7% for UGIB and LGIB (Chevallier et al 2021 ). There is paucity of data regarding recurrence of bleeding after embolization with EVOH: in the only published meta-analysis available, a rebleeding rate of 7.6% was described, which was higher in case of hemoptysis, compared to gastrointestinal hemorrhage (Kolber et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

“…Major complications following TE with coils and other non-liquid embolic agents range may occur in up to 23% (Maleux et al 2009 , Ahmed et al 2010 , Navuluri et al 2012 ) of patients. The use of NBCA for embolization of non-variceal gastrointestinal bleeding has been associated with a major complication rate of 8.6% (Chevallier et al 2021 ), whereas major complication rate after embolization with EVOH has been described as low as 3.1% (Kolber et al 2015 ). In the present series 6 major complication were recorded (2.8%).…”

Section: Discussionmentioning

confidence: 99%

Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study

et al. 2023

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Background To evaluate feasibility, safety and effectiveness of transarterial embolization of acute non-neurologic hemorrhage with Ethylene Vynil Alcohol Copolymer (EVOH). Methods Between January 2018 and June 2021, 211 patients (male 123, mean age 69.7 y + 17.9) who underwent transarterial embolization with Onyx™ for acute non-neurologic arterial bleeding were retrospectively reviewed. Most frequent etiology of bleeding was post-operative (89/211, 42.2%), trauma (62/211, 29.4%) and tumor (18/211, 8.5%). Technical success was defined as the angiographic evidence of target vessel complete occlusion. Clinical success was defined as resolution of bleeding. Any rebleeding within the primitive site, requiring a new intervention during the first 30-days following embolization, was considered a clinical failure. Occurrence of procedure-related complication and mortality within 30 days of the embolization were examined. Results A total of 229 embolization procedures was performed in 211 pts.; technical success rate was 99.5% (210/211 pts). Clinical success rate was 94.3% (199/211 pts). In 11 patients (5.2%) a reintervention was needed because of a rebleeding occurring within the primitive site, whereas in five patients (2.4%) rebleeding occurred within a site different from the primitive. Factors more often associated with clinical failure were coagulopathy/ongoing anticoagulant therapy (5/11, 45.4%), and post-operative etiology (3/11, 27.3%). EVOH was used as the sole embolic agent in 214/229 procedures (93.4%), in association with coils in 11 cases (4.8%), and with microparticles in 4 cases (1.7%). In the present series, major complications occurred in 6 cases (2.8%): respectively, four cases (1.9%) of colonic ischemia and two groin hematomas (0.9%) with active extravasation were observed. 26 (12.3%) patients died during the follow-up. Conclusion Embolization of acute arterial bleeding with EVOH as a first-line embolic agent is feasible, safe and effective.

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“…To our knowledge, the present study is the first to explore the use of NBCA glue in this indication. Whereas the use of NBCA has widely been reported in acute bleeding setting to achieve hemostasis [ 55 , 56 ], few papers reported its use for tumor devascularization [ 34 , 35 ]. NBCA offers several advantages.…”

Section: Discussionmentioning

confidence: 99%

Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience

Lopez¹,

Chevallier²,

Guillen³

et al. 2021

JCM

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The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In this single-center retrospective study of 19 consecutive high-risk patients (median age, 74 years) with renal malignancies managed in 2017–2020 by SAE with NBCA followed by PCA, data about patients, tumor and procedures characteristics, complications, renal function and hemoglobin concentration before and after treatment, as well as recurrence were collected. Charlson comorbidity index was ≥4 in 89.5% of patients. Ten patients were treated by antiplatelet and/or anticoagulant therapy. Median tumor largest diameter was 3.75 cm (range, 1–6.5 cm) and R.E.N.A.L. nephrometry score was ≥7 in 80%, indicating substantial tumor complexity. No major complications were recorded and minor complications occurred in 7 patients. No residual tumor was found at 6-week imaging follow-up in 18/19 patients. Tumor recurrence was visible in 1/16 patients at 6-month imaging follow-up. No significant difference was found for renal function after treatment (p = 0.07), whereas significant decrease in hemoglobin concentration was noted (p = 0.00004), although it was relevant for only one patient who required only blood transfusion and no further intervention. SAE prior to PCA is safe and effective for managing renal malignancies in high-risk patients.

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Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis

Cited by 32 publications

References 55 publications

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study

Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience

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