Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review

Abstract

Background Acute non-variceal gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. Main body Through the PubMed, Embase and Google Scholar database, an extensive search was performed in the fields of empiric and preventive embolization for the treatment of upper and lower gastrointestinal bleedings (UGIB and LGIB). Inclusion criteria were: articles in English for which it has been possible to access the entire content; adults patients treated with empiric or blind transcatheter arterial embolization (TAE) for UGIB and/or LGIB. Only studies that analysed clinical and technical success rate of blind and empiric TAE for UGIB and/or LGIB were considered for our research. Exclusion criteria were: recurrent articles from the same authors, articles written in other languages, those in which the entire content could not be accessed and that articles were not consistent to the purposes of our research. We collected pooled data on 1019 patients from 32 separate articles selected according to the inclusion and exclusion criteria. 22 studies focused on UGIB (total 773 patients), one articles focused on LGIB (total 6 patients) and 9 studies enrolled patients with both UGIB and LGIB (total 240 patients). Technical success rate varied from 62% to 100%, with a mean value of 97.7%; clinical success rate varied from 51% to 100% with a mean value of 80%. The total number of complications was 57 events out of 1019 procedures analysed. Conclusion TAE is an effective procedure in the treatment of UGIB patients in which angiography does not demonstrate direct sign of ongoing bleeding. The attitude in the treatment of LGIBs must be more prudent in relation to poor vascular anastomoses and the high risk of intestinal ischemia. Blind and preventive procedures cumulatively present a relatively low risk of complications, compared to a relatively high technical and clinical success.

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

“…Roberts highlighted a 6.1% complication rate, demonstrating safety in bleeding ruptured VAPs [ 66 ]. Furthermore, the safety results of our report, including vascular access site complications, align with previous studies conducted on endovascular treatments and transcatheter arterial embolization [ 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. Finally, this retrospective multicenter study provides further evidence supporting the safety and efficacy of endovascular embolization using EVOH copolymer-based non-adhesive liquid embolic agents (NALEAs) for the management of visceral pseudoaneurysms.…”

A Multicenter Retrospective Cohort Study Evaluating the Clinical Outcomes of Patients with Coagulopathy Undergoing Transcatheter Arterial Embolization (TAE) for Acute Non-Neurovascular Bleeding

“…Transcatheter arterial embolization (TAE) is the mainstay of treatment for acute major hemorrhage [ 1 , 2 , 3 ]. A multitude of conditions, including trauma, tumors, iatrogenic injuries, and coagulation disorders, can cause major acute bleeding and may benefit from TAE [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings

“…In agreement with several previous studies and meta-analyses, our results have confirmed TAE as a valuable therapeutic option for GIB, with high technical and clinical success and a low complication rate[ 33 , 34 ]. More specifically, a high technical success and favourable clinical outcomes were previously reported for TAE procedure in about 80% of patients with detected upper GIB and in lower GIB unresponsive to systemic therapy that cannot be managed in any other way[ 2 ].…”

“…Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition leading to high mortality and morbidity rates, especially in those patients with delayed treatment or multiple comorbidities[ 1 , 2 ]. Due to the increasing life expectancy and the ever more frequent employment of oral anticoagulant agents, GIB has become a greater health concern in the Western world[ 3 - 5 ].…”