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Wu W, Peng J, Zhou G, Zhang C, Lin Y, Weng Z. Efficacy of transcatheter arterial embolization in treating nonvariceal gastric remnant bleeding: a retrospective 5-year study. BMC Gastroenterol 2024; 24:92. [PMID: 38438915 PMCID: PMC10910776 DOI: 10.1186/s12876-024-03179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Gastric remnant bleeding is a special case of upper gastrointestinal bleeding with certain specific disease characteristics, and some matters of transcatheter arterial embolization (TAE) for hemostasis need attention. In this study, we aimed to explore the clinical use of TAE in patients with nonvariceal gastric remnant bleeding and identify the factors influencing the clinical efficacy of these interventions. METHODS Data were retrospectively analyzed from 42 patients for whom angiography and embolization were performed but could not be treated endoscopically or had failed endoscopic management in our department between January 2018 and January 2023 due to nonvariceal gastric remnant bleeding. We investigated the relationship between the incidence of re-bleeding and the following variables: sex, age, pre-embolization gastroscopy/contrast-enhanced computer tomography, embolization method, aortography performance, use of endoscopic titanium clips, and the presence of collateral gastric-supplying arteries. RESULTS Forty-two patients underwent 47 interventional embolizations. Of these, 16 were positive for angiographic findings, and 26 were negative. Based on arteriography results, different embolic agents were selected, and the technical success rate was 100%. The incidence of postoperative re-bleeding was 19.1% (9/47), and the overall clinical success rate was 81.0% (34/42). Logistic regression analysis of the relationship between the incidence of early re-bleeding following embolization and the proportion of collateral gastric supply arteries revealed an odds ratio of 10.000 (p = 0.014). CONCLUSIONS Utilizing TAE for nonvariceal gastric remnant bleeding is safe and effective. The omission of collateral gastric-supplying arteries can lead to early re-bleeding following an intervention.
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Affiliation(s)
- Weida Wu
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China
| | - Jianyang Peng
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China
| | - Guohui Zhou
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China
| | - Chunsheng Zhang
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China
| | - Yuanzhen Lin
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China
| | - Zhicheng Weng
- School Of Clinical Medicine, Fujian Medical University, 350000, Fuzhou, China.
- Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, 351100, Putian, Fujian Province, China.
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Zhu Y, Yang W, Zhang Y, Ye L, Hu B. The value of endoscopically-placed metal clips for transcatheter arterial embolization in the treatment of recurrent acute non-variceal upper gastrointestinal bleeding. BMC Gastroenterol 2023; 23:396. [PMID: 37974065 PMCID: PMC10652441 DOI: 10.1186/s12876-023-03034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is a common clinical emergency. Transcatheter arterial embolization (TAE) is usually used to locate the bleeding site and provide interventional embolization. During TAE, there is a low positive rate of angiography, and localization of the culprit vessel is difficult. The purpose of this study was to demonstrate the role of preplaced metal clips in TAE for ANVUGIB patients. MATERIALS AND METHODS Patients with ANVUGIB in whom bleeding sites were identified endoscopically and treated with TAE from January 1st, 2005 to July 1st, 2021 were retrospectively included. According to the presence or absence of preplaced metal clips, they were divided into two groups. The main outcome measurements included the clinical success rate and rebleeding rate. Secondary outcome measurements included the mortality rate and the need for surgery. Predictors of the clinical success rate were assessed with univariate analysis and multivariate analysis. RESULTS A total of 102 patients were included in this study, and all of them had undergone arterial embolization. There were 73 cases in the group with metal clips and 29 cases in the group without metal clips with consistent baseline information. The group with metal clips had a higher clinical success rate (82.2% vs. 45.0%, P < 0.001), lower rebleeding rate (8.2% vs 27.6%, P = 0.039) and additional surgery rate (11.0% vs 20.7%, P < 0.001) than the group without metal clips. In univariate analysis, ROCKALL score and preplaced metal clip marking were shown to affect clinical success rate. In multivariate analysis, metal clip marking was found to facilitate clinical success (OR = 3.750, 95CI = 1.456-9.659, P = 0.004). CONCLUSION In ANVUGIB patients, preplaced metal clips could improve the clinical success rate of TAE and reduce the mortality rate and the risk of rebleeding.
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Affiliation(s)
- Yinong Zhu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China
| | - Wenjuan Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China
| | - Yuyan Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China.
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Akay T, Leblebici M. Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding: A case series analysis observational study. Medicine (Baltimore) 2021; 100:e28480. [PMID: 34967393 PMCID: PMC8718225 DOI: 10.1097/md.0000000000028480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB.Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0-2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2-4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64).Early bleeding and permanent hemostasis were higher in Group 2 (P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups (P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 (P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively.In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.
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Affiliation(s)
- Tamer Akay
- Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey
| | - Metin Leblebici
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, General Surgery Department, Istanbul, Turkey
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Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L, Ren Y. Clinical efficacy of coil embolization in treating pseudoaneurysm post-Whipple operation. Exp Ther Med 2020; 20:37. [PMID: 32952628 PMCID: PMC7480126 DOI: 10.3892/etm.2020.9164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/24/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to evaluate the clinical efficacy and safety of angiography and coil embolization for pseudoaneurysm post-pancreatoduodenectomy (PD). A total of 17 patients with gastrointestinal or abdominal hemorrhage after PD were included in the present study. Angiography was performed on the celiac artery, common hepatic artery, splenic artery, gastroduodenal artery and superior mesenteric artery to determine the size of the pseudoaneurysm, the parent artery and its collateral branches. A variety of embolization techniques have been applied to embolize pseudoaneurysm, including the sac packing technique, proximal embolization, exclusion technique and sandwich technique. Different techniques with coils were used for embolization and the clinical effects of embolization were analyzed. A total of 18 pseudoaneurysms were identified in 17 patients. In 2 patients, severe technical complications occurred, including migration of the coil and rupture of pseudoaneurysm, and one of them died, which may have been associated with this complication. No serious clinical complications were observed in the other patients. A total of 7 patients had mild clinical complications, including mild abdominal and dorsal pain, which were alleviated after symptomatic management. A total of 15 patients with definite pseudoaneurysm were successfully embolized without re-bleeding and complications. The clinical success rate was 94.1% (16/17). In conclusion, a variety of embolization techniques may be applied for the treatment of pseudoaneurysm after PD, which have high technical and clinical success rates and small trauma. It is recommended in emergency situations, but care should be taken to avoid serious technical complications.
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Affiliation(s)
- Hao Xu
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cong Jing
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xuli Min
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jing Zhao
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yongjun Ren
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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Park M, Kim JW, Shin JH. Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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