Role of super‐selective embolization in lower gastrointestinal bleeding

Senadeera, Sajith C.; Vun, Simon; Butterfield, Nicholas; Eglinton, Tim; Frizelle, Frank

doi:10.1111/ans.14441

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…Reported rate of bowel ischemia after embolization ranged from 0% to 22% in the literature[8,12,17]. In this study, no patient developed bowel infarction.…”

Section: Discussionmentioning

confidence: 48%

Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

2019

WJCC

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BACKGROUNDAcute gastrointestinal bleeding is an emergency condition that can lead to significant morbidity and mortality. Embolization is considered the preferred therapy in the treatment of lower gastrointestinal bleeding when it is unrealistic to perform the surgery or vasopressin infusion in this population. Treatment of acute lower gastrointestinal (GI) bleeding (any site below the ligament of Treitz) using this technique has not reached a consensus, because of the belief that the risk of intestinal infarction in this condition is extremely high. The purpose of the study is to evaluate the effectiveness and safety of this technique in a retrospective group of patients who underwent embolization for acute lower GI bleeding.AIMTo evaluate the efficacy and safety of super-selective arterial embolization in the management of acute lower GI bleeding.METHODSA series of 31 consecutive patients with angiographically demonstrated small intestinal or colonic bleeding was retrospectively reviewed. The success rate and complication rate of super-selective embolization were recorded.RESULTSFive out of thirty-one patients (16.1%) could not achieve sufficiently selective catheterization to permit embolization. Initial control of bleeding was achieved in 26 patients (100%), and relapsed GI bleeding occurred in 1 of them at 1 wk after the operation. No clinically apparent bowel infarctions were observed in patients undergoing embolization.CONCLUSIONSuper-selective embolization is a safe therapeutic method for acute lower GI bleeding, and it is suitable and effective for many patients suffering this disease. Importantly, careful technique and suitable embolic agent are essential to the successful operation.

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“…Reported rate of bowel ischemia after embolization ranged from 0% to 22% in the literature[8,12,17]. In this study, no patient developed bowel infarction.…”

Section: Discussionmentioning

confidence: 48%

Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

2019

WJCC

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“…[19] However, recent studies have shown that the incidence of serious ischemic complications of TAE for LGIB was very low (0–5.2%). [14,15] Such improvements in the incidence of AEs depend largely on technical advances such as the development of guide wires and catheter systems that enable super-selective embolization in TAE. Super-selective embolization of the nearest arcade of the vasa recta of the segmental branch is important to prevent TAE-related AEs, including intestinal ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…The technical success rate of TAE for LGIB is high, at 93% to 100%, and the rebleeding rate after TAE for CDB is low, at 13% to 14.3%. [13][14][15] TAE may thus offer a useful alternative method for achieving hemostasis in CDB with extravasation on CECT.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of transcatheter arterial embolization for first-line treatment of colonic diverticular bleeding with extravasation on contrast-enhanced computed tomography

et al. 2022

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Colonic diverticular bleeding (CDB) is the most frequent cause of acute lower gastrointestinal bleeding. The aim of this study was to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for CDB as first-line treatment with extravasation on contrast-enhanced computed tomography (CECT), compared with endoscopic hemostasis. Three Japanese institutions participated in this retrospective cohort study. Data from consecutive patients admitted with a diagnosis of CDB with extravasation on CECT were reviewed. One hospital performed TAE and the others conducted urgent colonoscopy (CS) as the first-line treatment for CDB with extravasation on CECT. The primary outcome was rebleeding rate within 30 days after first-line treatment. In total, 165 CDB cases with extravasation on CECT (TAE group, n = 39; CS group, n = 126) were analyzed in this study. The rebleeding rate within 30 days was significantly lower in the TAE group (7.69%) than in the CS group (23.02%; P = .038). The bleeding point detection rate was significantly higher in the TAE group (89.74%, 35/39) than in the CS group (37.30%, 47/126; P < .0001). Even in those cases in which a bleeding point was detected, the rebleeding rate was significantly lower in the TAE group (0%) than in the endoscopic hemostasissuccess group (23.91%; P = .005). No severe complications of Grade 3 or more were seen with TAE. We showed that TAE is an effective, safe hemostatic method, and a useful alternative to endoscopic hemostasis for first-line treatment of CDB.

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“…Patient related factors such as age, aetiology of bleed and comorbidities have proven important predictors of outcome in some studies. 11,12 Others have evaluated angiographic-related factors, demonstrating an association between negative angiographic findings and lower rebleeding rates, 13 and a higher rebleeding rate when embolisation was delayed, 14 and targeted over prophylactic embolisation leading to angiographic success. 15,16 Previous work examining the effects of treatment-related factors indicates that greater red blood cell transfusion requirements were associated with a higher rate of rebleeding.…”

Section: Introductionmentioning

confidence: 99%

Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding

Delf

Ramachandran

Martin

et al. 2023

BJR

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Objectives: Evaluate clinical outcomes in transarterialembolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30 day reintervention for rebleeding and mortality. Methods: TAE cases were retrospectively reviewed between March 2010–September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Univariate and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30 day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding. Results: TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20–95 years) for acute upper GIB (n = 88) and lower GIB (n = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop >40 g l−1 from baseline based on univariate analysis (p = 0.047). 30 day mortality was associated with pre-intervention platelet count <150×109/L (p < 0.001, OR7.35, 95% CI 3.05–17.71) and INR >1.4 (p < 0.001, OR4.75, 95% CI 2.03–11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30 day mortality. Conclusions: TAE had excellent technical success for GIB with relatively high (1-in-5) 30 day mortality. INR >1.4 and platelet count <150×109/L were individually associated with TAE 30 day mortality, and pre-TAE >40 g l−1 haemoglobin decline with rebleeding requiring reintervention. Advances in knowledge: Recognition and timely reversal of haematological risk factors may improve TAE peri-procedural clinical outcomes.

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Role of super‐selective embolization in lower gastrointestinal bleeding

Abstract: SSE was successful in a high proportion of patients in this series with low complication rates. Clinical success was higher in those who were older or with diverticular related bleeding.

Cited by 11 publications

References 11 publications

Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

Efficacy of transcatheter arterial embolization for first-line treatment of colonic diverticular bleeding with extravasation on contrast-enhanced computed tomography

Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding

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