Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage

Abstract

Background-The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated with high morbidity and mortality. Percutaneous embolotherapy, previously considered a high risk procedure in the colon, may provide an alternative treatment in this group of patients. Aims-To assess the safety and eYcacy of embolotherapy in the treatment of life threatening colonic haemorrhage. Patients and methods-Thirty eight patients with fresh haemorrhage per rectum were referred for surgery because of failed conservative treatment. All underwent angiography; in 14 a bleeding site or vascular abnormality was detected. A coaxial catheter was directed to the most distal bleeding artery and this was embolised with platinum coils. Results-Detection of a bleeding site correlated with haemodynamic stability at the time of angiography (r=1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalities were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bleed and required emergency hemicolectomy (14%). Three developed ischaemic complications (21.4%); these were managed conservatively and required no intervention. The 30 day mortality was 7.1% in the embolotherapy group and 10.5% in the overall group of 38 patients. Conclusion-Colonic embolotherapy for life threatening haemorrhage is an eVective, relatively safe procedure with a low incidence of major complications. Its use depends on the identification of a focal bleeding point or vascular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography. (Gut 1998;43:79-84)

Quality Improvement Guidelines for Transcatheter Embolization for Acute Gastrointestinal Nonvariceal Hemorrhage

“…Persistence of melena or hematemesis within 12-24 h after the procedure should not be considered a clinical failure if not associated with clear laboratory or clinical signs of blood loss and should not indicate the need for a reintervention. Acute significant bleeding is generally considered as bleeding requiring transfusion of at least 4 units of blood within 24 h or causing signs of hemodynamic instability and shock (hypotension systolic BP of\100, tachycardia[100) [8][9][10]. 0.1 ml/min [11].…”

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

“…Several recent reports describe the safety and efficacy of super-selective angioembolization, but the long-term outcomes after selective embolization remain poorly evaluated [10][11][12][13].…”

Colocutaneous fistula complicating therapeutic mesenteric embolisation

“…Ischaemic strictures are late complications following embolisation, 7 but fistulation has never been reported. This phenomenon results from transmural ischaemia.…”