Interventional management of lower gastrointestinal bleeding

Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage

OBJECTIVES

We sought to assess the safety, short- and long-term efficacy, and durability of transcatheter embolization for lower gastrointestinal hemorrhage (LGH) unresponsive to endoscopic therapy and to analyze the overall survival of the embolized patients.

METHODS

Between January 1997 and January 2008, 122 patients were referred for angiographic evaluation to control major LGH. Overall, 43 patients (35.3%) presented with angiographic signs of contrast extravasation. In 39 patients (26 men, 13 women; mean age 67.7 years), a transcatheter embolization was performed to stop the bleeding.

RESULTS

In all 39 patients, no contrast extravasation could be depicted on completion of angiography after embolization. Rebleeding occurred in eight patients (20%), in six of them within the first 30 days after embolization. Ischemic intestinal complications requiring surgery occurred in four patients (10%) within 24 h after embolization. Long-term follow-up depicted estimated survival rates of 70.6, 56.5, and 50.8% after 1, 3, and 5 years, respectively.

CONCLUSIONS

Transcatheter embolotherapy to treat lower gastrointestinal bleeding is very effective, with a relatively low rebleeding and ischemic complication rate, mostly occurring within the first month after the embolization. Long-term follow-up shows a very low late rebleeding rate, and half of the embolized patients survive more than 5 years. This study shows that the majority of patients presenting with lower gastrointestinal bleeding, unresponsive to endoscopic therapy, do not benefit from transcatheter embolization. In cases of angiography extravasation, a good immediate clinical outcome-defined as high immediate success with acceptable rebleeding-and ischemic complication rate may be obtained.

Angiography and transcatheter embolizaion for acute lower gastrointestinal hemorrhage: clinical value and influencing factors of diagnosis and treatment

AIM: To evaluate the clinical value of angiography and transcatheter embotherapy in patients with acute massive lower gastrointestinal (GI) hemorrhage, and to analyze the influencing factors.

METHODS: We retrospectively analyzed data of 39 cases with acute massive arterial hemorrhage of lower gastrointestinal tract, including such data as transfusion amount, blood pressure and hemoglobin (Hb) before and after embolization. Baseline, procedural, and outcome parameters were recorded in accordance with current Society of Interventional Radiology guidelines. Follow-up time was three to six months. Outcomes included technical success (Immediate disappearance of bleeding signs or obstruction of leaking-blood artery after embotherapy), clinical success (without rebleeding within 30 days), delayed rebleeding (more than 30 days), and major or minor complication rates.

RESULTS: Twenty-six patients of the 39 with acute massive lower GI hemorrhage received blood transfusion before embolization, and only 4 patents with HB below 40 g/L before embolization, received the transfusion post-embolization. The positive diagnostic rates of lower GI hemorrhage of angiograms were 31% with catheter-tips located at 2^nd-grade-blood vessels (superior mesenteric arteries, inferior mesenteric arteries), and 69% at 3^rd-grade-blood vessels (jejunal artery, iliac artery, iliac-cecal artery, cecal artery, and marginal artery), respectively. The total positive diagnostic rate of angiography about lower GI bleeding reached 100%. Embolization was performed with injection of gelatin sponge particles or thin strips via catheter following angiogram with angiographical catheter (5French size) or with microcatheter (3French size). Immediate cessation bleeding post-embolization was 92%. The technical success rates and clinical success rates reached 100% and 89.7%, respectively. Transient epigastric pains occurred to 4 patients because of superior mesenteric artery spasm, 2 cases were managed with medications, and the others were relieved spontaneously. Three days after transcatheter embolization, endoscopy examination of four patients showed the areas of mucosal erythema, swelling and pallor. None of major complications was found such as necrosis or serious ischemia of lower GI.

CONCLUSION: Angiography and transcatheter embolization are effective and safe methods to locate the bleeding spot and stop bleeding immediately, which can be considered as alternatives to diagnosis and treatment of acute massive lower GI hemorrhage. The positive-bleeding-diagnostic rates of angiograms in lower GI hemorrhage and the efficacy of embolization are influenced by varied factors.