CardioVascular and Interventional Radiology

, Volume 35, Issue 6, pp 1346–1354 | Cite as

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

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 

Notes

Conflict of interest

N. Fidelman received research Grants from Nordion, Inc. and Bayer, Inc. All other authors have no conflict of interest.

References

  1. 1.
    Millward SF (2008) ACR Appropriateness Criteria® on treatment of acute nonvariceal gastrointestinal tract bleeding. J Am Coll Radiol 5:550–554PubMedCrossRefGoogle Scholar
  2. 2.
    Aina R, Olia VL, Therasse E et al (2001) Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 12:195–200PubMedCrossRefGoogle Scholar
  3. 3.
    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 7:515–523PubMedCrossRefGoogle Scholar
  4. 4.
    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 20:461–466PubMedCrossRefGoogle Scholar
  5. 5.
    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 158:547–549Google Scholar
  6. 6.
    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 3:61–65PubMedCrossRefGoogle Scholar
  7. 7.
    Morris DC, Nicholas DM, Connell DG et al (1986) Embolization of the left gastric artery in the absence of angiographic extravasation. Cardiovasc Intervent Radiol 9:195–198PubMedCrossRefGoogle Scholar
  8. 8.
    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 43:217–222PubMedCrossRefGoogle Scholar
  9. 9.
    De Wispelaere JF, De Ronde T, Trigaux JP et al (2002) Duodenal ulcer hemorrhage treated by embolization: results in 28 patients. Acta Gastroenterol Belg 65:6–11PubMedGoogle Scholar
  10. 10.
    Defreyne L, De Schrijver I, Decruyenaere J et al (2008) Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol 31:897–905PubMedCrossRefGoogle Scholar
  11. 11.
    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 12:1263–1271PubMedCrossRefGoogle Scholar
  12. 12.
    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 143:457–461PubMedCrossRefGoogle Scholar
  13. 13.
    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 33:1088–1100PubMedCrossRefGoogle Scholar

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

Personalised recommendations