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Patient and endoscopic characteristics and clinical outcomes in subjects with non-variceal GI bleeding referred for transarterial embolization: a single-center experience

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Management of massive non-variceal upper gastrointestinal bleeding (NV-UGIB) can be challenging. Transarterial Embolization (TAE) is often the first therapeutic approach when endoscopic therapy fails before surgery. The purpose of this study is to analyze the technical success, and outcome for our patients with an NV-UGIB referred for TAE.

Method

This retrospective analysis included 74 consecutive patients with an NV-UGIB in whom TAE was performed after endoscopic treatment between February 2016 to May 2019 at Prisma Health-Upstate Greenville Memorial Hospital.

Results

TAE was 98.7% technically successful, with a failure due to severe celiac stenosis, and 85.1% clinically successful. Most TAEs were performed empirically due to lack of extravasation yet were clinically as effective as targeted TAE. We noted a 30-day rebleeding rate and mortality rate of 14.8% and 13.5%, respectively. No complications were reported during the angiographic procedure. Subjects with coagulopathy had more rebleeding (45.5% vs. 17.5%, p = 0.040), and mortality (30% vs 7.4%, p = 0.012). Mortality was also associated with the number of transfused packed blood cells (13.6 ± 8.4 vs. 6.1 ± 5.4, p = 0.020) units and hypotension on admission (27.8% vs. 8.9%, p = 0.043). Interestingly, subjects that underwent left gastric artery (LGA) compared to non-LGA embolization had a higher rebleeding rate of (37.5% vs. 8.6%, p = 0.004) and a greater mortality rate of (37.5% vs. 6.9%, p = 0.002).

Conclusion

TAE is clinically effective in the presence or absence of contrast extravasation to treat uncontrolled or high-risk NV-UGIB. Less effective clinical outcomes regarding TAE targeting the LGA warrant further investigation.

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Authors and Affiliations

  1. Department of Medicine, Gastroenterology & Liver Center, Prisma Health- Upstate, Greenville, SC, 29605, USA

    Kripalini Ephraim Joseph

  2. Department of Diagnostic and Interventional Radiology, University of South Carolina SOM - Greenville, Prisma Health -Upstate, Greenville, SC, 29605, USA

    Aron M. Devane

  3. Department of Medicine, Gastroenterology & Liver Center, University of South Carolina SOM - Greenville, Prisma Health- Upstate, Greenville, SC, 29605, USA

    Gary A. Abrams

Authors
  1. Kripalini Ephraim Joseph
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Contributions

All authors contributed to the study's conception and design. Data collection and analysis were performed by KEJ, AMD and, GAA. The first draft of the manuscript was written by KEJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kripalini Ephraim Joseph.

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Ephraim Joseph, K., Devane, A.M. & Abrams, G.A. Patient and endoscopic characteristics and clinical outcomes in subjects with non-variceal GI bleeding referred for transarterial embolization: a single-center experience. Abdom Radiol 47, 3883–3891 (2022). https://doi.org/10.1007/s00261-022-03650-x

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