Superselective Microcoil Embolization of Colonic Hemorrhage

Funaki, Brian; Kostelic, Jonathan K.; Lorenz, Jonathan M.; Ha, Thuong Van; Yip, Doris; Rosenblum, Jordan D.; Leef, Jeffrey A.; Straus, Christopher M.; Zaleski, George X.

doi:10.2214/ajr.177.4.1770829

Cited by 165 publications

(98 citation statements)

References 16 publications

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“…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).…”

Section: Discussionsupporting

confidence: 53%

“…[7][8][9][10] However, innovations in coaxial technique have allowed for a superselective approach to bleeding vessels, resulting in continued high rates of haemostasis with reduced instances of ischaemia. Numerous studies in recent years have demonstrated this benefit, [11][12][13][14][15][16][17] contributing to the overall acceptance of embolization as a legitimate and even preferred treatment option in the management of acute massive colonic haemorrhage. Additionally, direct comparisons of embolotherapy with catheter-directed vasoconstrictive therapy (i.e.…”

Section: Discussionmentioning

confidence: 99%

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

Ahmed

Jilani

Sheth

et al. 2015

BJR

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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

Ahmed

Jilani

Sheth

et al. 2015

BJR

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“…The results of the initial attempts were associated with high recurrence rates and complications [15,16]. Significant advances in the embolization technique and devices (super-selective, microcatheters) and increased technical expertise have improved the adoption of this procedure for the treatment of lower gastrointestinal hemorrhage.…”

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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“…Diverticular bleeding has been reported to be the most common cause of lower gastrointestinal bleeding (4,5) and accounts for >40% of lower gastrointestinal bleeding (5). Colonic diverticular bleeding typically has a mild course and stops spontaneously without therapeutic intervention in approximately 70% to 80% of cases (5)(6)(7)(8). However, some cases require endoscopic, angiographic, and surgical treatment depending on the nature of the bleeding (5)(6)(7)(8), and the diagnostic and therapeutic strategy for colonic diverticular bleeding has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

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Objective Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding, and its incidence has recently increased. However, the treatment strategy of diverticular bleeding has not yet been established. The aim of the study was to investigate the efficacy of contrast-enhanced computed tomography (CECT) to determine the indication for urgent colonoscopy to achieve hemostasis. Methods A total of 124 patients diagnosed with diverticular bleeding between 2012 and 2013 in our hospital were analyzed. The clinical behavior, factors related to detecting bleeding diverticula, and risk factors for early rebleeding of diverticular bleeding were evaluated. Results Clinical behavior: Bleeding diverticula were identified in 23 of 124 (19%) patients and most of them (16/23; 70%) were located in the ascending colon. Hemostasis was achieved in all 23 cases, however, six (26%) developed early rebleeding. Factors for detecting bleeding diverticula: In patients in whom extravasation was detected using CECT, the endoscopic detection rate of bleeding diverticula was 60% (12/20), while bleeding diverticula were detected in only 31% (11/35) of patients in whom extravasation was not detected using CECT (p<0.05). The interval between the first hematochezia and colonoscopy in which the bleeding point was detected by colonoscopy (median 23.5 hours) was shorter than that in which bleeding diverticula were not detected (median 43.6 hours) (p<0.01). Risk factors for short term rebleeding: Using a univariate analysis, atherosclerotic comorbidity, anti-inflammatory drugs including low-dose aspirin, antithrombotic agents, vital signs on admission, hemoglobin level on hospitalization, and extravasation on CECT were not found to be significant risk factors. Conclusion The finding of extravasation on CECT is the most important factor for identifying and treating bleeding diverticula by colonoscopy. In such cases, urgent colonoscopy is recommended.

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Superselective Microcoil Embolization of Colonic Hemorrhage

Abstract: Therapeutic microcoil embolization for severe colonic hemorrhage is an effective and well-tolerated procedure.

Cited by 165 publications

References 16 publications

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

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

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

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

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