Embolization as a First Approach with Endoscopically Unmanageable Acute Nonvariceal Gastrointestinal Hemorrhage

Defreyne, Luc; Vanlangenhove, Peter; Vos, Martine De; Pattyn, Piet; Maele, Georges Van; Decruyenaere, Johan; Troisi, Roberto; Kunnen, Marc

doi:10.1148/radiology.218.3.r01mr05739

Cited by 187 publications

(126 citation statements)

References 45 publications

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“…In previous case studies that analyzed from 9 to 84 patients, the clinical success rates of TAE with NBCA for gastrointestinal tract bleeding ranged from 82% to 96.4% [11,14,16,23]. Our current study, which included a larger patient sample size, had a success rate of 76.5% (78/102), which is relatively lower than those in previous reports.…”

Section: Discussioncontrasting

confidence: 60%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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ing, renal arterial bleeding, and even gastrointestinal tract bleeding [2][3][4][5][6][7][8]. NBCA is highly penetrable because of its liquid nature and is less affected by coagulopathies; thus, it may be used as an adjunct to other embolic materials to ensure the embolic effect [9,10]. However, NBCA is difficult to handle effectively and safely and is inherently more prone to cause ischemic necrosis.Although there have been several reports on the use of TAE with NBCA for acute gastrointestinal tract bleeding, 9-84 patients were included in those studies, and neither long-term clinical data nor analyses evaluating clinical factors affecting the clinical success of NBCA were presented [11][12][13][14][15][16]. Therefore, studies in larger patient populations are warranted to determine the clinical effectiveness of NBCA in the setting of acute gastrointestinal tract bleeding, with or AJR 2015; 204:662-668 0361-803X/15/2043-662 © American Roentgen Ray Society E ndoscopy is a rapid diagnostic and therapeutic modality that is widely accepted as the preferred method for identifying and providing hemostasis at sites of gastrointestinal tract bleeding. In cases of endoscopic treatment failure or where the site of bleeding is inaccessible by endoscopy, such as distal small-bowel bleeding, transcatheter arterial embolization (TAE) may be an effective alternative to endoscopy. A previous study showed that TAE in the management of gastrointestinal tract bleeding is effective with good long-term clinical outcomes [1]. Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc hAmong the various embolic materials that have been evaluated, N-butyl-2-cyanoacrylate (NBCA) was first used to embolize cerebral aneurysms but now is widely used for controlling active bleeding, including intramuscular hemorrhage, uterine arterial bleed- OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes.MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests.RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancerrelated bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% ...

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Section: Discussioncontrasting

confidence: 60%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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“…Gastroenterologists usually choose between two treatment modalities for hemostasis, endoscopic hemostasis and transarterial embolization (TAE), depending on the patient's medical condition [9,10]. Because TAE is a more invasive procedure than endoscopic hemostasis, TAE is mostly performed after the failure of endoscopic hemostasis for gastric bleeding [11,12]. For this reason, endoscopic hemostasis is regarded as the first-line treatment and TAE is regarded as a first-or second-line treatment for gastric bleeding.…”

Section: Introductionmentioning

confidence: 99%

The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer

et al. 2012

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Background When patients with advanced gastric cancer experience active bleeding, gastroenterologists normally choose between two treatment modalities, endoscopic hemostasis and transarterial embolization (TAE). In patients with advanced gastric cancer with bleeding, the predictive factors for endoscopic hemostatic failure are still unknown. Thus, the purpose of this study was to evaluate predictive factors for endoscopic hemostasis failure and to differentiate which hemostasis procedure is more effective for advanced gastric cancer with bleeding. Methods We reviewed the medical records of patients who were diagnosed with advanced gastric cancer and acute non-variceal gastric bleeding from January 2006 to August 2011. Forty-five patients were enrolled in this study and they were divided into a group of 14 patients who had experienced successful endoscopic hemostasis and a group of 31 patients who had had unsuccessful hemostasis with the first endoscopy and then underwent TAE. Results Lesion size and bleeding condition of Forrest class 1a or 1b were statistically significant predictive factors for endoscopic hemostatic failure (P = 0.023 and P = 0.017, respectively). On multivariate logistic regression analysis, size (lesion [2 cm) was a significant predictive factor for endoscopic hemostatic failure [adjusted odds ratio (aOR) 8.056; 95 % confidence interval (CI) 1.329-48.846].Conclusions We determined that small bleeding lesions (\2 cm) and exposed vessels in the bleeding site with gastric cancer indicated that endoscopic hemostasis would be an effective hemostatic modality to choose. Particularly, in the opposite condition, the presence of large bleeding lesions ([2 cm) and non-exposed vessel bleeding with a tumor, endoscopic hemostasis failure is predicted and TAE could be recommended.

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“…In the last years, improvement in endoscopic techniques and medication have resulted in rebleeding rates lower than 15% [12]. In cases of unsuccessful endoscopic treatment, surgical hemostatic interventions are associated with a high mortality rate of 20 to 40% [13]. Various studies have shown that in cases of upper gastrointestinal bleeding transarterial embolization as compared to surgical hemostasis has proven to be equally effective while being less invasive; associated with a lower post-interventional mortality, and, thus, being accepted as the method of preference.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Embolization as a First Approach with Endoscopically Unmanageable Acute Nonvariceal Gastrointestinal Hemorrhage

Abstract: Embolization is an effective first approach with lower and transpapillar GIH after endoscopy; it was less effective with upper GIH.

Cited by 187 publications

References 45 publications

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer

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

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