Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Abstract

Background Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.Methods From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. Conclusion In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

Long-term results of microcoil embolization for colonic haemorrhage: how common is rebleeding?

“…We did, however, encounter one patient who had asymptomatic ischaemia noted on a follow-up colonoscopy prior to an elective bowel resection. Given that the rates of ischaemic events in past studies using endovascular technique with various embolic agents have been reported in the range of 3-21%, 4,16,27,28 our experience provides validation to the idea that the risk of ischaemia is lower with coils than with the other agents used for treatment (i.e. particulates, gelatin sponge and n-BCA liquid embolic).…”

“…Additionally, prior published data on endovascular technique is limited by a majority of studies using a combination of different embolic agents to manage lower GI bleeding, consequently confounding the evaluation for efficacy of any one single agent. 4,[11][12][13][14][15][17][18][19]25,27,28 The present study sought to address this concern by examining both early and delayed rebleeding rates in patients managed specifically by superselective microcoil embolization, yielding rates of 11.5% and 15.3%, respectively. These findings take an initial step at showing the ability to achieve long-term haemostasis in most patients treated by endovascular coiling alone.…”

“…Additionally, as most other published literature on transcatheter embolization is confounded by the usage of a variety of embolic agents, the results from this study show the overall low risk of ischaemia when microcoils are used in a superselective manner. 4,[11][12][13][14][15][17][18][19]25,27,28 The belief is that superselective coiling limits the area of embolization to the diseased or actively bleeding segment of large bowel in such a fashion that arrests bleeding but avoids end organ necrosis and ischaemia. 3 This is in contrast to other embolic agents such as particles, gelatin sponge or liquid embolic (i.e.…”

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

“…Our findings complement those of a recent study providing additional insights into the short-term outcomes of angiographic therapy and subsequent embolization in patients with GIB. [11][12][13] Management options for patients with acute nonvariceal upper GIB that does not respond to initial endoscopic treatment include repeat endoscopy, emergency surgery, and angiographic embolization. Several studies have compared the effectiveness of surgery to embolization in treating patients with GIB.…”

Therapeutic water soluble contrast-thrombin enema use in bleeding colonic diverticula: A case report

“…Mesenteric angiography and embolization is both diagnostic and therapeutic. There is a risk of bowel ischemia (16.7% in one study) from the procedure as well as the possibility of renal failure and contrast reactions in select patient populations [9]. Endoscopy can also be diagnostic through direct visualization and therapeutic with epinephrine injection, cauterization, or vessel clipping.…”