Upper Gastrointestinal Hemorrhage and Transcatheter Embolotherapy: Clinical and Technical Factors Impacting Success and Survival

Schenker, Matthew P.; Duszak, Richard; Soulen, Michael C.; Smith, Kirsten P.; Baum, Richard A.; Cope, Constantin; Freiman, David B.; Roberts, David A.; Shlansky-Goldberg, Richard D.

doi:10.1016/s1051-0443(07)61549-8

Cited by 179 publications

(104 citation statements)

References 28 publications

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“…This discrepancy in results may be an illustration of the heterogeneity of the population with GIB, making the generalizability of study results very difficult. 28 Almost all of the more recent series have reported a technical success rate of angioembolization of greater than 95%, 12,29,30 although the failure rate may be as high as 50%. 31 Repeat angiography may be equally effective.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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Background: Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. Methods:We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ 2 , Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses.Results: Eighteen of 83 (22%) patients had active extravasation on initial angiog raphy and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). Conclusion:The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

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Section: Discussionmentioning

confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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“…Advantages of using gelatin sponges include cost effectiveness, widespread availability, and temporary occlusion. These sponges are more commonly used in combination with coils and particles when bleeding occurs from a lesion that is not expected to heal spontaneously, such as tumors [33]. Coils and microcoils have become the preferred agent for embolizing upper gastrointestinal bleeding by most interventionalists.…”

Section: Agents Used For Embolizationmentioning

confidence: 99%

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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Bleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions. AbstractBleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. The objective of this article is to review the etiology, clinical manifestations, and treatment of acute upper gastrointestinal bleeding in cancer patients, understanding that chronic and occult blood losses are not within the scope of this text. To achieve better outcomes in the management of this entity, a multidisciplinary approach is mandatory. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions.

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“…Other negative predictive factors include older age, cirrhosis, oncologic diseases, multiple organ failure, and current corticosteroid treatment [7,56]. Generally, the morbidity and mortality associated with endovascular intervention is lower or comparable than for surgical procedure [28,42,[57][58][59].…”

Section: Outcomementioning

confidence: 99%

Quality Improvement Guidelines for Transcatheter Embolization for Acute Gastrointestinal Nonvariceal Hemorrhage

Válek

Hustý

2012

Cardiovasc Intervent Radiol

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Upper Gastrointestinal Hemorrhage and Transcatheter Embolotherapy: Clinical and Technical Factors Impacting Success and Survival

Cited by 179 publications

References 28 publications

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Upper Gastrointestinal Bleeding in Oncological Patients

Quality Improvement Guidelines for Transcatheter Embolization for Acute Gastrointestinal Nonvariceal Hemorrhage

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