The efficacy of transcatheter arterial embolization as the first‐choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors

Katano, Takahito; Mizoshita, Tsutomu; Senoo, Kyoji; Sobue, Satoshi; Tanaka, Hiroki; Sakamoto, Tomoyuki; Mochiduki, Hisato; Ozeki, Takanori; Kato, Akihisa; Matsunami, Katsuyoshi; Ito, Kazuyuki; Joh, Takashi

doi:10.1111/j.1443-1661.2012.01285.x

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…For patients with negative imaging, “blind embolization” remains controversial, but for patients with clear histories of surgery and endoscopic treatment failure, embolization is quite beneficial. [2,8] There were 4 patients who chose blind embolization, and 3 of them suffered from endoscopic treatment failure before the embolization. For patients with negative imaging and no clear etiology, we employed conservative treatment first and then performed DSA imaging again or performed CT or nuclear scans if necessary.…”

Section: Discussionmentioning

confidence: 99%

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage

Shi¹,

Yang²,

Liang³

et al. 2017

Medicine

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To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc., were used to embolize the targeted vessels. The angiographic manifestations and the effects of embolization of acute arterial massive hemorrhage of the GI tract were retrospectively analyzed.Of the 88 patients, 54 were diagnosed with arterial hemorrhage of the upper GI tract and 34 with arterial hemorrhage of the lower GI tract. Eighty cases were associated with positive angiography, which showed the following: contrast extravasation (only); gastroduodenal artery stenosis; pseudoaneurysm (only); pseudoaneurysm rupture with contrast extravasation; pseudoaneurysms merged with intestinal artery stenosis; GI angiodysplasia; and tumor vascular bleeding. Eight cases were diagnosed with negative angiography. Seven-two patients underwent successful hemostasis, and a total of 81 arteries were embolized. The technical and clinical success rates (no rebleeding within 30 days) in performing transcatheter embolization on patients with active bleeding were 100% and 84.71%, respectively (72 of 85). Within 30 days, the postoperative rebleeding rate was 15.29% (13/85). Of these rebleeding cases, 2 patients were formerly treated with "blind embolization," 7 underwent interventional embolic retreatment, and 3 had surgical operations. All cases were followed-up for 1 month, and 3 patients died from multiple organ failure. No serious complications such as bowel ischemia necrosis were observed.ETAE is a safe, effective, and minimally invasive treatment; because of the diversified arteriographic manifestations of acute GI hemorrhage, the proper selection of embolic agents and the choice of reasonable embolization method are essential for successful hemostasis.

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Section: Discussionmentioning

confidence: 99%

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage

Shi¹,

Yang²,

Liang³

et al. 2017

Medicine

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“…All of these studies found that TAE reduced the number of complications and the need for surgery without increasing overall mortality. Although several studies have demonstrated that TAE is useful for treating acute hemorrhage from UGI ulcers,28,29,30 the choice of TAE or surgery after a failed endoscopic treatment depended on the discretion of the operating surgeon or physician. Moreover, the selection of TAE or surgery after a failed endoscopic treatment might also be affected by institutional TAE limitations.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients

et al. 2014

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Background/AimsDespite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcers repeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at a high risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis.MethodsWe analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24 hours of arrival at the hospital.ResultsDurable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest types Ia, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysis indicated that age ≥70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI, 2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposed vessels with a diameter of ≥2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21; 95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis.ConclusionsVarious factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is important for patients at a high risk for incomplete hemostasis.

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“…TAE reduced the number of complications and the need for surgery without increasing overall mortality 7,8,9. Although several studies have demonstrated the use of TAE for treating acute hemorrhage from UGI ulcers,10,11 the choice of TAE or surgery after failed endoscopic treatment depended on the discretion of the operating surgeon or physician and the interventional radiologist. As the authors mentioned as a limitation of their study, only one patient received TAE after a failed third endoscopic hemostasis; this situation results in a high rate of operations or morbidity related to surgery.…”

mentioning

confidence: 99%

Predictive Factors for Endoscopic Hemostasis in Patients with Upper Gastrointestinal Bleeding

Chung

2014

Clin Endosc

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The efficacy of transcatheter arterial embolization as the first‐choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors

Abstract: TAE is a safe and effective first-choice treatment for patients in whom endoscopic hemostasis has failed.

Cited by 19 publications

References 31 publications

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage

Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients

Predictive Factors for Endoscopic Hemostasis in Patients with Upper Gastrointestinal Bleeding

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