Predictors for outcomes after super‐selective mesenteric embolization for lower gastrointestinal tract bleeding

Abstract

Mesenteric embolization was found to be safe and effective in treating LGIB (100% technical success, no post-embolization ischaemia), with 65.4% of cases not requiring further intervention. Low platelet count prior to embolization appears to be associated with clinical failure.

Acute Lower Gastrointestinal Hemorrhage

“…Technical success rate is high and has been reported in multiple series at 80 to 100%. 36,37,[48][49][50][51][52][53][54][55] Inability to catheterize small and tortuous distal target vessels is the most commonly cited reason for technical failure. 37,50 Clinical success rate is similar, reported at 71 to 100%, 37 owing to multiple contributory factors, including incomplete embolization in cases of multiple vessels supplying the hemorrhage, recanalization of an embolized artery in the setting of coagulopathy, recruitment of collateral vessels, and presence of a second site of bleeding.…”

“…However, with modern technology and techniques enabling superselective embolotherapy, major ischemic complication rates have been substantially reduced, with many series reporting rates near 0%. 36,37,48,51,52,54,56 While postembolization bowel ischemia may rarely require surgical interven-tion or result in death, most of the reported ischemic complications are minor-clinically insignificant, incidentally found, and/or conservatively managed. 37,56 In addition, the rate of delayed ischemic complication manifesting as obstructive bowel stricture is also very low according to studies with longer term follow-up.…”

Predicting the need for transfer and interventional angiography for patients with acute colonic haemorrhage in a regional setting

“…Acute colonic bleeding defined as bleeding from the colon, rectum or anus accounts for 20–30% of all hospital admissions with gastrointestinal bleeding . Colonic bleeding has an incidence of 35.7 to 87/100 000 persons/year increasing to over 205/100 000 in persons over the age of 80 .…”

“…Patients with colonic bleeding are often referred for angioembolization if intravascular contrast extravasation (a ‘blush’) is demonstrated on computed tomography mesenteric angiography (CTMA), indicating active haemorrhage . Angioemenbolization has an important role in management in these instances, enabling localization of the bleeding source and targeted vessel occlusion, potentially avoiding the need for colonoscopy (which can be technically challenging in the presence of a blood‐filled and unprepared colon) or emergency proctocolectomy . Angioembolization, which has been extensively examined in centres with on‐site access to interventional angiography (IA) has an important role in its management; however, evidence is lacking in units without direct access to IA.…”

“…Angioemenbolization has an important role in management in these instances, enabling localization of the bleeding source and targeted vessel occlusion, potentially avoiding the need for colonoscopy (which can be technically challenging in the presence of a blood‐filled and unprepared colon) or emergency proctocolectomy . Angioembolization, which has been extensively examined in centres with on‐site access to interventional angiography (IA) has an important role in its management; however, evidence is lacking in units without direct access to IA. Outcome in units without direct access to IA have not been reported on.…”