Transcatheter Arterial Embolization of Gastrointestinal Bleeding with N-Butyl Cyanoacrylate: A Systematic Review and Meta-Analysis of Safety and Efficacy

Singh

Journal of Clinical Interventional Radiology ISVIR

et al. 2020

Purpose The main purpose of this article is to assess the outcomes of endovascular management of pancreatitis-related hemorrhage. Materials and Methods Retrospective analysis of patients referred for endovascular management of pancreatitis-related bleeding from January 2010 to December 2017 was performed. Patients’ demographics, clinical presentation, etiology, laboratory findings, angiography findings, details of the endovascular procedure, technical outcome, clinical outcome, and complications were assessed. Results One hundred and five patients with a mean age of 37 years were included in this study. Splenic artery (41.7%) was the most commonly involved vessel. Middle colic, left colic, superior mesenteric, jejunal, left inferior phrenic, and left renal subcapsular arteries were the less commonly involved vessels. Embolization was performed using coils in 72 (68.5%) patients, n-butyl cyanoacrylate (n-BCA) in 21 (20%) patients, both coil and n-BCA in 8 (7.6%) patients, and 4 (3.8%) patients underwent stent graft placement. Technical success was achieved in 98% (n = 103) and clinical success in 93.2% (n = 96) of patients. Rebleeding was seen in 6.8% (n = 7) of patients. Six patients with rebleeding were managed by reintervention. Four patients had rebleeding from the same vessel, and two patients had rebleeding from a different vessel. One patient died due to massive rebleeding. Minor complications were seen in 14.2% (n = 15), major complications were seen in 3.8% (n = 4), and mortality rate was 0.9% (n = 1). Conclusion Endovascular treatment is effective in the management of pancreatitis-related bleeding and is associated with low rebleeding rate and low mortality rate.

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Pancreatitis-Related Hemorrhage: Single-Center Experience

Singh

Journal of Clinical Interventional Radiology ISVIR

et al. 2020

Videosurgery and Other Miniinvasive Techniques

“…However, surgery was reported to be superior to TAE when treating gastrointestinal bleeding related to gastrointestinal lymphoma, as most of the cases of rebleeding occurred at new sites and ischemic bowel complications proved to be possible after repeated TAE treatment [ 27 ]. Research results on the technical aspects of TAE have recently been published – Morishita et al had success using the “balloon blocking” technique for superselective catheterization under balloon occlusion at the branching site of the target artery, and a systematic review and meta-analysis by Kim et al found that embolization using N-butyl cyanoacrylate (NBCA) is effective for gastrointestinal bleeding [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

Širvinskas

Smolskas

Mikelis

et al. 2017

IntroductionTranscatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment.AimTo analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality.Material and methodsA retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization.ResultsThe technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01).ConclusionsIn our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

“…Moreover, as mentioned earlier, all current evidence indicates that glue is no more effective than coils in patients with coagulopathies. 4 Detachable coils can be used but are more expensive and rarely necessary in my experience.…”

Section: Embolic Agent? Glue Vs Coilsmentioning

confidence: 95%

“…It is important to recognize that despite common belief to the contrary, the most comprehensive review of cyanoacrylate embolization concluded that this agent was not effective in patients with coagulopathies. 4 Finally, of course, correcting coagulopathies may be the only "therapy" needed to achieve hemostasis in some patients, obviating any further intervention.…”

Section: Coagulopathiesmentioning

confidence: 99%

Gastrointestinal Bleeding on Call: Questions and Answers and One Person's Opinions

Funaki

2020

Semin intervent Radiol

Gastrointestinal (GI) bleeding represents one of the more morbid forms of hemorrhage that interventional radiologists deal with on an on-call basis. Bleeding from the GI tract takes many forms and has many etiologies. While venous bleeds from varices are often treated emergently with placement of a transjugular intrahepatic portosystemic shunt, arterial hemorrhages are treated most effectively with embolization procedures. Embolization must be performed in specific ways, however, in an effort to decrease the risk of bowel ischemia; this also requires choosing the right patients in whom to perform embolization procedures. This article will provide a discussion on when to perform embolization and how, what to do with specific patient populations such as those with coagulopathy, and which patients should be considered for emergent treatment versus those that can be postponed.