The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding

Abstract

IntroductionGastrointestinal bleeding (GIB) is a common problem that accounts for approximately 2% of hospital admissions. 1Although factors such as response to fluid resuscitation and/or transfusion, hypotension, the presence of shock, and coagulopathy are determinants of appropriate treatment strategy, 2 the majority of nonvariceal GIB resolves spontaneously.3 When bleeding persists, endoscopy is the mainstay for diagnosis and treatment and results in primary hemostasis in the majority of the cases. However, in a subset of patients, endoscopic therapy fails to halt bleeding, necessitating angiographic evaluation and transcatheter arterial embolization or surgery for bleeding control. 4 In patients who are poor surgical candidates or in those with an unclear source of bleeding, angiography cannot only provide information about the location and cause of bleeding but may allow therapeutic intervention to stop the Keywords ► gastrointestinal bleeding ► endoscopy ► angiography ► embolization AbstractBackground and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endovascular embolization in patients with nonvariceal GIB. Method Clinical records of 88 patients (mean age: 67.8 years) who underwent endovascular embolization for GIB were reviewed. Patient demographics, history, angiographic findings, treatment, and outcomes were recorded. The technical success of embolization, and the 24-hour and 30-day rebleeding and mortality rates were calculated. Multivariate analysis was performed to assess the factors associated with 24-hour and 30-day rebleeding. Results Angiography demonstrated signs of bleeding in 63 (71.6%) patients and all underwent selective embolization of the abnormal artery. Empiric embolization was performed in 25 patients. Embolization was performed with coils (n ¼ 45), Gelfoam (n ¼ 12), microparticles (n ¼ 14), glue (n ¼ 2), or a combination of these (n ¼ 15). The technical success rate was 96.6%. The 24-hour and 30-day rebleeding occurred in 13 (14.7%) and 16 (18.2%) patients, respectively. The 24-hour and 30-day mortality rates were 9.1 and 11.3%, respectively. Ischemic complications following embolization were seen in three patients, of which two required surgery. Based on the multivariate analysis, the need for continued transfusion after embolization and prior GIB were independent variables associated with 24-hour and 30-day rebleeding, respectively. Conclusions Endovascular embolization has a high technical and clinical success in patients presenting with nonvariceal GIB.

Nonvariceal Upper Gastrointestinal Hemorrhage: The Interventional Radiologist's Perspective

“…Patients with rebleeding following vasopressin infusion can be treated with a repeat infusion or embolization. 14 15 27 28…”