Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?
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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.
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.
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).
Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.
- Millward SF (2008) ACR Appropriateness Criteria® on treatment of acute nonvariceal gastrointestinal tract bleeding. J Am Coll Radiol 5:550–554 CrossRef
- Aina R, Olia VL, Therasse E et al (2001) Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 12:195–200 CrossRef
- Loffroy R, Guiu B, D’Athis P et al (2009) Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: Predictors of early rebleeding. Clin Gastroenterol Hepatol 7:515–523 CrossRef
- Padia SA, Geisinger MA, Newman JS et al (2009) Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol 20:461–466 CrossRef
- Lang EV, Picus D, Marx MV, Hicks ME, Friedland GW (1992) Massive upper gastrointestinal hemorrhage with normal findings on arteriography: value of prophylactic embolization of the left gastric artery. Am J Roentgenol 158:547–549
- Walsh RM, Anain P, Geisinger M, Vogt D, Mayes J, Grundfest-Broniatowski S et al (1999) Role of angiography and embolization for massive gastroduodenal hemorrhage. J Gastrointest Surg 3:61–65 CrossRef
- Morris DC, Nicholas DM, Connell DG et al (1986) Embolization of the left gastric artery in the absence of angiographic extravasation. Cardiovasc Intervent Radiol 9:195–198 CrossRef
- Larssen L, Moger T, Bjornbeth BA et al (2008) Transcatheter arterial embolization in the management of bleeding duodenal ulcers: a 5.5-year study of treatment and outcome. Scand J Gastroenterol 43:217–222 CrossRef
- De Wispelaere JF, De Ronde T, Trigaux JP et al (2002) Duodenal ulcer hemorrhage treated by embolization: results in 28 patients. Acta Gastroenterol Belg 65:6–11
- Defreyne L, De Schrijver I, Decruyenaere J et al (2008) Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol 31:897–905 CrossRef
- Schenker MP, Duszak R Jr, Soulen MC et al (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol 12:1263–1271 CrossRef
- Poultsides GA, Kim CJ, Orlando R III, Peros G, Hallisey MJ, Vignati PV (2008) Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg 143:457–461 CrossRef
- Loffroy R, Rao P, Ota S et al (2010) Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol 33:1088–1100 CrossRef
- Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?
CardioVascular and Interventional Radiology
Volume 35, Issue 6 , pp 1346-1354
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- Gastrointestinal hemorrhage
- Empiric embolization
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- Author Affiliations
- 1. Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94134, USA
- 2. Department of Radiology, Hadassah Hospital, Jerusalem, Israel