CardioVascular and Interventional Radiology

, Volume 35, Issue 6, pp 1346–1354

Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

  • Elnasif Arrayeh
  • Nicholas Fidelman
  • Roy L. Gordon
  • Jeanne M. LaBerge
  • Robert K. KerlanJr.
  • Alexander Klimov
  • Allan I. Bloom
Clinical Investigation

DOI: 10.1007/s00270-012-0351-y

Cite this article as:
Arrayeh, E., Fidelman, N., Gordon, R.L. et al. Cardiovasc Intervent Radiol (2012) 35: 1346. doi:10.1007/s00270-012-0351-y

Abstract

Purpose

To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically.

Methods

Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.

Results

For patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006).

Conclusion

Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

Keywords

Gastrointestinal hemorrhage Angiography Empiric embolization 

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Elnasif Arrayeh
    • 1
  • Nicholas Fidelman
    • 1
  • Roy L. Gordon
    • 1
  • Jeanne M. LaBerge
    • 1
  • Robert K. KerlanJr.
    • 1
  • Alexander Klimov
    • 2
  • Allan I. Bloom
    • 2
  1. 1.Department of RadiologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of RadiologyHadassah HospitalJerusalemIsrael