Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

Abstract

Objective: This is a retrospective analysis of interventional embolisation performed with catheter angiography in 29 patients with upper gastrointestinal bleeding in the setting of a secondary care hospital. Patients, Materials, and Methods: From April 2007 to February 2013, 29 patients with upper gastrointestinal bleeding underwent endovascular diagnostics and treatment. The diagnosis was established by endoscopy, computed tomography or clinically based on a significant decrease in hemoglobin. Transcatheter arterial embolisation was performed with coils, liquid embolic agents, and particles. The technical and clinical outcomes were assessed by postinterventional endoscopy, hemoglobin concentrations, number of necessary transfusions, or surgical interventions, as well as by post-interventional mortality within 28 days after the procedure. Results: Selective angiographic embolisation in upper gastrointestinal bleeding was primarily successful technically and clinically in 22 of 29 patients. In 4/29 cases an angiographic reintervention was performed, which was successful in 3?cases. In 3 cases of primarily technically unsuccessful procedures reintervention was not attempted. No catheterisation-related complications were recorded. Peri-interventional mortality was 31?%, but only 2 of these patients died due to uncontrolled massive bleeding, whereas the lethal outcome in the other 7 patients was due to their underlying diseases. Conclusion: Transcatheter arterial embolisation is an effective and rapid method in the management of upper gastrointestinal bleeding. Radiological endovascular interventions may considerably contribute to reduced mortality in GI bleeding by avoiding a potential surgical procedure following unsuccessful endoscopic treatment. The study underlines the importance of the combination of interventional endoscopy with interventional radiology in secondary care hospitals for patient outcome in complex and complicated upper gastrointestinal bleeding situations.

Akute obere gastrointestinale Blutung

“…Auch ohne aktive Blutung können angiografisch Blutungsquellen indirekt loksalisiert werden, indem Gefäßmalformationen oder pathologische Gefäßkonvoluten bei Tumoren erkannt werden. Mit dieser Methode ist man in der Lage, das blutende Gefäß mittels supraselektiver Katheterisierung zu embolisieren -dies ist allerdings nur in 86 % der Fälle möglich[27].Klassifikation nach ForrestKriterium für Intervention und Prognose | Die 1974 eingeführte Klassifikation für Ulkusblutungen nach Forrest hat sich bis in die Gegenwart als Kriterium für den Interventionsbedarf und die Prognose bewährt [7] (▶ Tab. 2).…”

Coils migrate into the biliary-jejunum anastomosis

“…[1] For arterial bleeding, interventional radiologic techniques with coils embolization are always useful. [2,3] However, coils migration following endovascular treatment is rare. Only some case reports described this complication.…”