Long-Term Outcome of Transcatheter Embolotherapy for Acute Lower Gastrointestinal Hemorrhage

Maleux, Geert; Roeflaer, Filip; Heye, Sam; Vandersmissen, Jo; Vliegen, Anne-Sophie; Demedts, Ingrid; Wilmer, Alexander

doi:10.1038/ajg.2009.186

Cited by 64 publications

(61 citation statements)

References 22 publications

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“…Other authors found that presence of more than one comorbid condition was associated with increased overall mortality (12,13). Our technical success, clinical success, and rebleeding rates in patients with positive angiograms are similar to those published in other studies (3,(6)(7)(8). Tachycardia at first presentation was a predictor of both 30-day and overall mortality.…”

Section: Discussionsupporting

confidence: 78%

“…Surgery for lower GI bleeding is usually reserved for patients with uncontrollable bleeding and failed angiographic embolization, or postembolization ischemic bowel complications (6,15). We did not encounter major complications in the 120 procedures in our study.…”

Section: Discussionmentioning

confidence: 60%

“…If the diagnostic tests locate the bleeding, or if intractable bleeding occurs, more invasive test warrants arteriogram and possible intervention. While other authors have performed similar analyses of patients with lower GI bleeding who required conventional angiography, they differed from our study in that some analyzed upper and lower GI bleeds together (3, 4), or patients with negative angiograms were not factored into the analysis (5), or more importantly, the patients were not separated in terms of first-time versus multiple bleeders (3)(4)(5)(6)(7)(8). We aimed to analyze patients with acute lower GI bleeding who presented to the emergency department for the first time and required conventional angiography for localization of the bleed and potential endovascular treatment.…”

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confidence: 55%

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Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Sıldıroğlu¹,

Muasher²,

Bloom³

et al. 2018

Diagn Interv Radiol

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M ost acute lower gastrointestinal (GI) bleeding stop spontaneously; therefore, no intervention or invasive diagnostic test such as conventional angiography is necessary (1). Prior to mesenteric arteriogram, colonoscopy, flexible sigmoidoscopy, and radionuclide imaging are usually performed. Recently computed tomography (CT) angiography has demonstrated promising results (1, 2). If the diagnostic tests locate the bleeding, or if intractable bleeding occurs, more invasive test warrants arteriogram and possible intervention. While other authors have performed similar analyses of patients with lower GI bleeding who required conventional angiography, they differed from our study in that some analyzed upper and lower GI bleeds together (3, 4), or patients with negative angiograms were not factored into the analysis (5), or more importantly, the patients were not separated in terms of first-time versus multiple bleeders (3)(4)(5)(6)(7)(8). We aimed to analyze patients with acute lower GI bleeding who presented to the emergency department for the first time and required conventional angiography for localization of the bleed and potential endovascular treatment. We also wanted to identify a subgroup of procedural factors, comorbidities associated with rebleeding, technical success, clinical success and mortality in association with lower gastrointestinal bleeds. Methods PatientsInstitutional review board approved this retrospective study. Consecutive cases of acute lower GI bleeding between 2001 and 2012 were reviewed retrospectively. We included all 23This project was an oral presentation in ARRS annual meeting in 2012. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to investigate patients with lower gastrointestinal bleeding who presented to the emergency department requiring initial conventional angiography. We report risk-stratified and mesenteric conventional angiography outcomes. METHODSWe retrospectively reviewed patients with lower gastrointestinal bleeding between 2001 and 2012. We included all consecutive patients with clinical lower gastrointestinal bleeding with a requirement of further angiography and possible embolization. Patients who had prior interventions or surgery were excluded. RESULTSA total of 88 patients (35 women, 53 men) with a median age of 71 years (range, 23-99 years) were included in the analysis. Conventional angiography was positive and endovascular treatment was intended in 35 patients. Once the source of bleeding was found angiographically, endovascular treatment had a technical success rate of 90.3% and clinical success rate of 71.4%. Overall early rebleeding rate (<30 days) was 14.8% and late rebleeding rate (>30 days) was 13.6%. CONCLUSIONIdentifying the source of lower gastrointestinal bleeding remains to be a clinical and angiographic challenge. Although we did not observe an association between mortality and clinical success, increased early rebleeding rates were associated with higher mortality rates.You may cite this article as: Sıl...

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 55%

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Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Sıldıroğlu¹,

Muasher²,

Bloom³

et al. 2018

Diagn Interv Radiol

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“…[19][20][21] However, it requires specialized equipment and experienced interventional radiologists, preventing its widespread access beyond large centres. It has been shown, albeit in retrospective studies only, to be at least as equally effective as surgery after endoscopic failure for acute UGIB.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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Background: Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. Methods:We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ 2 , Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses.Results: Eighteen of 83 (22%) patients had active extravasation on initial angiog raphy and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). Conclusion:The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

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“…Radiologic embolotherapy is considered to be a salvage therapy with reported technical success rates of 69-100% and rebleeding rates of 10-30% within 30 days of initial application [Luchtefeld et al 2000;Weldon et al 2008]. A major adverse event of embolotherapy is the increased risk of bowel ischemia or infarct after arterial embolization, which has been reported to range from 0% to 22% [Maleux et al 2009].…”

Section: Introductionmentioning

confidence: 99%

Hemostatic powder spray: a new method for managing gastrointestinal bleeding

Changela

Papafragkakis

Ofori

et al. 2015

Therap Adv Gastroenterol

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Gastrointestinal bleeding is a leading cause of morbidity and mortality in the United States. The management of gastrointestinal bleeding is often challenging, depending on its location and severity. To date, widely accepted hemostatic treatment options include injection of epinephrine and tissue adhesives such as cyanoacrylate, ablative therapy with contact modalities such as thermal coagulation with heater probe and bipolar hemostatic forceps, noncontact modalities such as photodynamic therapy and argon plasma coagulation, and mechanical hemostasis with band ligation, endoscopic hemoclips, and over-the-scope clips. These approaches, albeit effective in achieving hemostasis, are associated with a 5-10% rebleeding risk. New simple, effective, universal, and safe methods are needed to address some of the challenges posed by the current endoscopic hemostatic techniques. The use of a novel hemostatic powder spray appears to be effective and safe in controlling upper and lower gastrointestinal bleeding. Although initial reports of hemostatic powder spray as an innovative approach to manage gastrointestinal bleeding are promising, further studies are needed to support and confirm its efficacy and safety. The aim of this study was to evaluate the technical feasibility, clinical efficacy, and safety of hemostatic powder spray (Hemospray, Cook Medical, Winston-Salem, North Carolina, USA) as a new method for managing gastrointestinal bleeding. In this review article, we performed an extensive literature search summarizing case reports and case series of Hemospray for the management of gastrointestinal bleeding. Indications, features, technique, deployment, success rate, complications, and limitations are discussed. The combined technical and clinical success rate of Hemospray was 88.5% (207/234) among the human subjects and 81.8% (9/11) among the porcine models studied. Rebleeding occurred within 72 hours post-treatment in 38 patients (38/234; 16.2%) and in three porcine models (3/11; 27.3%). No procedure-related adverse events were associated with the use of Hemospray. Hemospray appears to be a safe and effective approach in the management of gastrointestinal bleeding.

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Long-Term Outcome of Transcatheter Embolotherapy for Acute Lower Gastrointestinal Hemorrhage

Cited by 64 publications

References 22 publications

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Hemostatic powder spray: a new method for managing gastrointestinal bleeding

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