Skip to main content

Transcatheter Embolotherapy for Gastrointestinal Bleeding: A Single Center Review of Safety, Efficacy, and Clinical Outcomes

Digestive Diseases and Sciences volume 58, pages 1976–1984 (2013)Cite this article

Abstract

Purpose

The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding.

Materials and Methods

Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 %) patients had upper GI bleeds and 19/95 (20 %) patients had lower GI bleeds. A mean of 7 (range 0–27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 %) procedures were urgent or emergent. Twenty-seven of 95 (28 %) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates.

Results

Bleeding etiology included peptic ulcer disease (45/95, 47 %), cancer (14/95, 15 %), diverticulosis (13/95, 14 %), and other (23/95, 24 %). Vessels embolized (n = 109) included gastroduodenal (42/109, 39 %), pancreaticoduodenal (22/109, 20 %), gastric (21/109, 19 %), superior mesenteric (12/109, 11 %), inferior mesenteric (8/109, 7 %), and splenic (4/109, 4 %) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 %) cases. Most common embolic agents included coils (66/109, 61 %) and/or gelatin sponge (19/109, 17 %). Targeted versus empiric embolization were performed in 57/95 (60 %) and 38/95 (40 %) cases, respectively. Complications included bowel ischemia (4/95, 4 %) and coil migration in 3/95 (3 %). 30-day rebleeding rate was 23 % (22/95). Overall 30-day mortality rate was 18 % (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 %) but higher mortality (31 vs 9 %) rates compared to embolization for active extravasation.

Conclusions

TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Adler DG, Leighton JA, Davila RE, et al. ASGE guideline: the role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc. 2004;60:497–504.

    PubMed  Article  Google Scholar 

  2. Davila RE, Rajan E, Adler DG, et al. ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc. 2005;62:656–660.

    PubMed  Article  Google Scholar 

  3. Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. 1995;90:568–573.

    PubMed  CAS  Google Scholar 

  4. Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering committee and members of the national audit of acute upper gastrointestinal haemorrhage. BMJ. 1995;311:222–226.

    PubMed  Article  CAS  Google Scholar 

  5. Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–1010 (quiz 1955).

    Google Scholar 

  6. Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol. 2003;14:535–543.

    PubMed  Article  Google Scholar 

  7. Weldon DT, Burke SJ, Sun S, Mimura H, Golzarian J. Interventional management of lower gastrointestinal bleeding. Eur Radiol. 2008;18:857–867.

    PubMed  Article  Google Scholar 

  8. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol. 2011;66:500–509.

    PubMed  Article  CAS  Google Scholar 

  9. Angle JF, Siddiqi NH, Wallace MJ, et al. Quality improvement guidelines for percutaneous transcatheter embolization: society of interventional radiology standards of practice committee. J Vasc Interv Radiol. 2010;21:1479–1486.

    PubMed  Article  Google Scholar 

  10. Brown DB, Cardella JF, Sacks D, et al. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol. 2006;17:225–232.

    PubMed  Article  Google Scholar 

  11. Baum S, Nusbaum M, Blakemore WS, Finkelstein AK. The preoperative radiographic demonstration of intra-abdominal bleeding from undetermined sites by percutaneous selective celiac and superior mesenteric arteriography. Surgery. 1965;58:797–805.

    PubMed  CAS  Google Scholar 

  12. Baum S, Nusbaum M. The control of gastrointestinal hemorrhage by selective mesenteric arterial infusion of vasopressin. Radiology. 1971;98:497–505.

    PubMed  CAS  Google Scholar 

  13. Funaki B. Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage. Gastroenterol Clin North Am. 2002;31:701–713.

    PubMed  Article  Google Scholar 

  14. Bookstein JJ, Chlosta EM, Foley D, Walter JF. Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology. 1974;113:277–285.

    PubMed  CAS  Google Scholar 

  15. Goldberger LE, Bookstein JJ. Transcatheter embolization for treatment of diverticular hemorrhage. Radiology. 1977;122:613–617.

    PubMed  CAS  Google Scholar 

  16. Rosch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology. 1972;102:303–306.

    PubMed  CAS  Google Scholar 

  17. Miller M Jr, Smith TP. Angiographic diagnosis and endovascular management of nonvariceal gastrointestinal hemorrhage. Gastroenterol Clin North Am. 2005;34:735–752.

    PubMed  Article  Google Scholar 

  18. Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010;33:1088–1100.

    PubMed  Article  Google Scholar 

  19. Wong TC, Wong KT, Chiu PW, et al. A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointest Endosc. 2011;73:900–908.

    PubMed  Article  Google Scholar 

  20. Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol. 2001;12:195–200.

    PubMed  Article  CAS  Google Scholar 

  21. Schenker MP, Duszak R Jr, Soulen MC, et al. Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol. 2001;12:1263–1271.

    PubMed  Article  CAS  Google Scholar 

  22. Loffroy R, Guiu B, D’Athis P, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7:515–523.

    PubMed  Article  Google Scholar 

  23. Arrayeh E, Fidelman N, Gordon RL, et al. Transcatheter arterial embolization for upper gastrointestinal nonvariceal hemorrhage: is empiric embolization warranted? Cardiovasc Intervent Radiol. 2012;35:1346–1354.

    Google Scholar 

  24. Padia SA, Geisinger MA, Newman JS, Pierce G, Obuchowski NA, Sands MJ. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol. 2009;20:461–466.

    PubMed  Article  Google Scholar 

  25. Chang WC, Liu CH, Hsu HH, et al. Intra-arterial treatment in patients with acute massive gastrointestinal bleeding after endoscopic failure: comparisons between positive versus negative contrast extravasation groups. Korean J Radiol. 2011;12:568–578.

    PubMed  Article  Google Scholar 

  26. Ichiro I, Shushi H, Akihiko I, Yasuhiko I, Yasuyuki Y. Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications. J Vasc Interv Radiol. 2011;22:911–916.

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Department of Radiology, Section of Interventional Radiology, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL, 60612, USA

    Felix Y. Yap, Jeet Minocha, M. Grace Knuttinen, Charles A. Owens, James T. Bui & Ron C. Gaba

  2. College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL, 60612, USA

    Benedictta O. Omene, Milan N. Patel & Thomas Yohannan

Authors
  1. Felix Y. Yap
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benedictta O. Omene
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Milan N. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Yohannan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeet Minocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Grace Knuttinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles A. Owens
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James T. Bui
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ron C. Gaba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ron C. Gaba.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Yap, F.Y., Omene, B.O., Patel, M.N. et al. Transcatheter Embolotherapy for Gastrointestinal Bleeding: A Single Center Review of Safety, Efficacy, and Clinical Outcomes. Dig Dis Sci 58, 1976–1984 (2013). https://doi.org/10.1007/s10620-012-2547-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-012-2547-z

Keywords

  • Gastrointestinal bleeding
  • Transcatheter embolotherapy
  • Safety
  • Efficacy