Mesenteric Embolization for Lower Gastrointestinal Bleeding

Gillespie, Carla; Sutherland, Andrew D.; Mossop, Peter; Woods, Rodney; Keck, James; Heriot, Alexander G.

doi:10.1007/dcr.0b013e3181e10e90

Cited by 59 publications

(43 citation statements)

References 21 publications

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“…These factors should be considered for prompt surgical intervention in those high-risk patients. [24] 32 patients Immediate hemostasis 97 % Ischemia rate 1 % Gillespie et al [27] 38 patients Immediate hemostasis 100 % Ischemia rate 8 % Rebleeding rate 24 % Koganemaru et al [28] 4 patients Immediate hemostasis 100 % Ischemia rate 0 % Rebleeding rate 0 % Finally, ischemia remains the main problem, and the risk decreased with better embolization technique. Recently, Tan et al [26] described only one patient (3 %) suffering from ischemic complications that required immediate surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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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.

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Section: Discussionmentioning

confidence: 99%

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

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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“…It has been reported that the bleeding site is identified by angiography only in 24-48% of patients [108][109][110]. Different embolic materials such as metallic coils and nbutylcyanoacrylate are used in clinical practice, with no significant differences among them.…”

Section: Cq19: Is Arterial Embolization Effective For Colonic Divertimentioning

confidence: 99%

“…Different embolic materials such as metallic coils and nbutylcyanoacrylate are used in clinical practice, with no significant differences among them. The technical success rate is normally around 67-98% but was 100% when the number of patients was small [80,[108][109][110][111][112][113][114]. The rebleeding rate is 12-50% [108][109][110], so patients need to be followed up carefully even when hemostasis is achieved.…”

Section: Cq19: Is Arterial Embolization Effective For Colonic Divertimentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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“…In a recent review, mesenteric angiography for lower gastrointestinal bleeding effectively identifies the site of bleeding in 48% of patients and allows embolisation in 45%. Embolisation achieves clinical success in 76% of patients but repeat embolisation was associated with a higher rate of complications [27].…”

Section: Angiographymentioning

confidence: 99%

Surgical management of lower gastrointestinal bleeding

Pfeifer

2011

Eur J Trauma Emerg Surg

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Mesenteric Embolization for Lower Gastrointestinal Bleeding

Abstract: Mesenteric angiography for lower gastrointestinal bleeding effectively identifies the site of bleeding in 48% of patients and allows embolization in 45%. Embolization achieves clinical success in 76% of patients but repeat embolization is associated with a high rate of complications.

Cited by 59 publications

References 21 publications

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

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

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Surgical management of lower gastrointestinal bleeding

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