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Toro Tole D, Maurel A, Hedger J, Kwan S, Weber D. A systematic review of failed endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding. J Gastrointest Surg 2024; 28:309-315. [PMID: 38446116 DOI: 10.1016/j.gassur.2023.12.020] [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: 10/26/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a surgical emergency, usually managed via endoscopy. Approximately 2% of patients will have another significant bleed after therapeutic endoscopy and may require either transarterial embolization (TAE) or surgery. In 2011, the National Institute for Health and Care Excellence guidelines recommended that TAE should be the preferred option offered in this setting. METHODS This study aimed to conduct an appraisal of guidelines on NVUGIB using the Appraisal of Guidelines for Research and Evaluation II tool. A specific review of their recommendations on the management of adult patients with failed endoscopic hemostasis that required TAE or surgery was conducted. RESULTS The quality of the guidelines was moderate; most could be recommended with changes. However, their recommendations regarding TAE vs surgery were widely heterogeneous. A closer review of the underpinning evidence showed that most studies were retrospective, with a small sample size and missing data. CONCLUSION Because of the heterogeneity in evidence, the decision regarding TAE vs surgery requires further research. Deciding between these modalities is primarily based on TAE availability and patient comorbidities. However, surgery should not be dismissed as a key option after failed endoscopic hemostasis.
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Affiliation(s)
- David Toro Tole
- Department of Surgery, Royal Darwin Hospital, Darwin, Australia.
| | - Amelie Maurel
- Department of Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Joe Hedger
- School of Medicine, Flinders University, Darwin, Australia.
| | - Sherman Kwan
- Department of Surgery, Royal Perth Hospital, Perth, Australia
| | - Dieter Weber
- Department of Surgery, Royal Perth Hospital, Perth, Australia
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Gong T, Tsauo J, Ding M, Jin L, Duan F, Yu Y, Li X. Transcatheter arterial embolization for cancer-related non-variceal upper gastrointestinal bleeding: A multicenter retrospective study of 107 patients. Diagn Interv Imaging 2023; 104:60-66. [PMID: 36114135 DOI: 10.1016/j.diii.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate the outcome of transcatheter arterial embolization (TAE) in the treatment of cancer-related non-variceal upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS One-hundred and seven patients who underwent TAE for the treatment of cancer-related non-variceal UGIB at five institutions between June 2016 and May 2019 were retrospectively included. There were 78 men and 29 women, with a mean age of 60.6 ± 13.2 (SD) (age range: 31-87 years). Clinical success was defined as no rebleeding within 30 days after TAE. Rebleeding was defined as non-variceal UGIB resulting in a decrease in hemoglobin > 2 g/dL within 24 h. The Kaplan-Meier method was used to estimate actuarial probabilities of rebleeding and survival within 30 days after TAE. Univariable and multivariable analyses were performed to identify variables associated with clinical success and 30-day mortality. RESULTS Technical success was achieved in 106 out of 107 patients (99.1%). Positive angiographic findings (contrast extravasation and pseudoaneurysm) were observed in 30/107 patients (28.0%). Empiric embolization was performed in 77/107 patients (72.0%). Clinical success was achieved in 60/107 patients (56.1%). The 3-day, 7-day, and 30-day actuarial probabilities of rebleeding were 21.5%, 31.0%, and 44.6%, respectively. No variables were identified as predictors of clinical success. Nineteen patients (19/107; 17.8%) died within 30 days after TAE; of them, 14 (14/107; 13.1%) died due to bleeding-related causes. The 3-day, 7-day, and 30-day actuarial probabilities of survival were 91.6%, 88.8%, and 77.4%, respectively. A baseline hemoglobin level of ≤ 60 g/L (Odds ratio [OR]: 3.376; 95% confidence interval [CI]: 1.223-9.318; P = 0.019) and clinical failure (OR: 6.149; 95% CI: 2.113-17.893; P = 0.001) were identified as predictors of 30-day mortality. Major complications (gastrointestinal perforation) occurred in one patient (1/107; 0.9%). Minor complications (abdominal pain, fever, and vomiting) occurred in 19 patients (19/107; 17.8%). CONCLUSION TAE is a safe treatment option for patients with cancer-related non-variceal UGIB, and seems to be effective in more than half of these patients.
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Affiliation(s)
- Tao Gong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiaywei Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Mingchao Ding
- Department of Peripheral Vascular Intervention, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, China
| | - Long Jin
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Feng Duan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Youtao Yu
- Department of Interventional Radiology, The Fourth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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3
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Rabuffi P, Bruni A, Antonuccio EMG, Saraceni A, Vagnarelli S. Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study. CVIR Endovasc 2023; 6:2. [PMID: 36697892 PMCID: PMC9877256 DOI: 10.1186/s42155-023-00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To evaluate feasibility, safety and effectiveness of transarterial embolization of acute non-neurologic hemorrhage with Ethylene Vynil Alcohol Copolymer (EVOH). METHODS Between January 2018 and June 2021, 211 patients (male 123, mean age 69.7 y + 17.9) who underwent transarterial embolization with Onyx™ for acute non-neurologic arterial bleeding were retrospectively reviewed. Most frequent etiology of bleeding was post-operative (89/211, 42.2%), trauma (62/211, 29.4%) and tumor (18/211, 8.5%). Technical success was defined as the angiographic evidence of target vessel complete occlusion. Clinical success was defined as resolution of bleeding. Any rebleeding within the primitive site, requiring a new intervention during the first 30-days following embolization, was considered a clinical failure. Occurrence of procedure-related complication and mortality within 30 days of the embolization were examined. RESULTS A total of 229 embolization procedures was performed in 211 pts.; technical success rate was 99.5% (210/211 pts). Clinical success rate was 94.3% (199/211 pts). In 11 patients (5.2%) a reintervention was needed because of a rebleeding occurring within the primitive site, whereas in five patients (2.4%) rebleeding occurred within a site different from the primitive. Factors more often associated with clinical failure were coagulopathy/ongoing anticoagulant therapy (5/11, 45.4%), and post-operative etiology (3/11, 27.3%). EVOH was used as the sole embolic agent in 214/229 procedures (93.4%), in association with coils in 11 cases (4.8%), and with microparticles in 4 cases (1.7%). In the present series, major complications occurred in 6 cases (2.8%): respectively, four cases (1.9%) of colonic ischemia and two groin hematomas (0.9%) with active extravasation were observed. 26 (12.3%) patients died during the follow-up. CONCLUSION Embolization of acute arterial bleeding with EVOH as a first-line embolic agent is feasible, safe and effective.
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Affiliation(s)
- Paolo Rabuffi
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Antonio Bruni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Enzo Maria Gabriele Antonuccio
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Andrea Saraceni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Simone Vagnarelli
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
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Kim HC, Jeong YS, Han K, Kim GM. Transcatheter arterial embolization of cystic artery bleeding. Front Surg 2023; 10:1160149. [PMID: 37114149 PMCID: PMC10126234 DOI: 10.3389/fsurg.2023.1160149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose The purpose of this study is to assess the safety and clinical outcomes of transcatheter arterial embolization (TAE) via the cystic artery for treating patients with bleeding from the cystic artery. Materials and Methods This retrospective study included 20 patients who underwent TAE via the cystic artery between January 2010 and May 2022. Radiological images and clinical data were reviewed to evaluate causes of bleeding, procedure-related complications, and clinical outcomes. Technical success was defined as the disappearance of contrast media extravasation or pseudoaneurysm, as demonstrated on completion angiography. Clinical success was defined as discharge from the hospital without any bleeding-related issues. Results Hemorrhagic cholecystitis (n = 10) was the most common cause of bleeding, followed by iatrogenic (n = 4), duodenal ulcer (n = 3), tumor (n = 2), and trauma (n = 1). Technical success was achieved in all cases, and clinical success was achieved in 70% (n = 14) of patients. Three patients developed ischemic cholecystitis as a complication. Six patients with clinical failure died within 45 days after embolization. Conclusion TAE through the cystic artery has a high technical success rate in treating cystic artery bleeding, but clinical failure remains a common occurrence due to concurrent medical conditions and the development of ischemic cholecystitis.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Soo Jeong
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Correspondence: Gyoung Min Kim
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Ko G, Choi JW, Lee N, Kim D, Hyeon T, Kim HC. Recent progress in liquid embolic agents. Biomaterials 2022; 287:121634. [PMID: 35716628 DOI: 10.1016/j.biomaterials.2022.121634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022]
Abstract
Vascular embolization is a non-surgical procedure used to treat diseases or morbid conditions related to blood vessels, such as bleeding, arteriovenous malformation, aneurysm, and hypervascular tumors, through the intentional occlusion of blood vessels. Among various types of embolic agents that have been applied, liquid embolic agents are gaining an increasing amount of attention owing to their advantages in distal infiltration into regions where solid embolic agents cannot reach, enabling more extensive embolization. Meanwhile, recent advances in biomaterials and technologies have also contributed to the development of novel liquid embolic agents that can resolve the challenges faced while using the existing embolic materials. In this review, we briefly summarize the clinically used embolic agents and their applications, and then present selected research results that overcome the limitations of the embolic agents in use. Through this review, we suggest the required properties of liquid embolic agents that ensure efficacy, which can replace the existing agents, providing directions for the future development in this field.
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Affiliation(s)
- Giho Ko
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Nohyun Lee
- School of Advanced Materials Engineering, Kookmin University, Seoul 02707, Republic of Korea
| | - Dokyoon Kim
- Department of Bionano Engineering and Bionanotechnology, Hanyang University, Ansan 15588, Republic of Korea.
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
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Sasaki K, Okada T, Yamaguchi M, Tajiri M, Ahmed M, Gentsu T, Ueshima E, Sofue K, Sugimoto K, Murakami T. Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries. Jpn J Radiol 2021; 40:308-317. [PMID: 34613557 DOI: 10.1007/s11604-021-01203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. MATERIALS AND METHODS Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. RESULTS TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). CONCLUSION TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
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Affiliation(s)
- Koji Sasaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Masashi Tajiri
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Mostafa Ahmed
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Kim JS, Kim BW, Kim DH, Park CH, Lee H, Joo MK, Jung DH, Chung JW, Choi HS, Baik GH, Lee JH, Song KY, Hur S. [Guidelines for Non-variceal Upper Gastrointestinal Bleeding]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:322-332. [PMID: 32581203 DOI: 10.4166/kjg.2020.75.6.322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to bleeding that develops in the gastrointestinal tract proximal to the ligament of Treitz. NVUGIB is an important cause for visiting the hospital and is associated with significant morbidity and mortality. Although European and Asian-Pacific guidelines have been published, there has been no previous guidelines regarding management of NVUGIB in Korea. Korea is a country with a high prevalence of Helicobacter pylori infection and patients have easy accessibility to receive endoscopy. Therefore, we believe that guidelines regarding management of NVUGIB are mandatory. The Korean Society of Gastroenterology reviewed recent evidence and recommends practical management guidelines on NVUGIB in Korea.
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Affiliation(s)
- Joon Sung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyuk Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyo Young Song
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Dariushnia SR, Redstone EA, Heran MKS, Cramer HR, Ganguli S, Gomes AS, Hogan MJ, Himes EA, Patel S, Schiro BJ, Lewis CA. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization. J Vasc Interv Radiol 2021; 32:476.e1-476.e33. [PMID: 33640083 DOI: 10.1016/j.jvir.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303.
| | - Ellen A Redstone
- Department of Interventional Radiology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015
| | - Manraj K S Heran
- Pediatric Interventional Radiology, Diagnostic & Therapeutic Neuroradiology, British Columbia's Children's Hospital, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada
| | - Harry R Cramer
- Section of Interventional Radiology, Coastal Vascular and Interventional, PLLC, 3155 Hyde Park Place, Pensacola, FL, 32503
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH 4th Floor, Boston, MA, 02118
| | - Antoinette S Gomes
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plz Ste 2125, Los Angeles, CA, 90095-8358
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Sheena Patel
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Brian J Schiro
- Department of Vascular & Interventional Radiology, Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33156, United States
| | - Curtis A Lewis
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303
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Chevallier O, Comby PO, Guillen K, Pellegrinelli J, Mouillot T, Falvo N, Bardou M, Midulla M, Aho-Glélé S, Loffroy R. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis. Diagn Interv Imaging 2021; 102:479-487. [PMID: 33893060 DOI: 10.1016/j.diii.2021.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis to determine the safety, efficacy, and outcomes of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) as the single embolic agent for the management of non-variceal upper and lower gastrointestinal bleeding (GIB). MATERIALS AND METHODS A literature search using MEDLINE/PubMed, EMBASE, and SCOPUS databases was performed for studies published from January 1980 to December 2019. Data from eligible studies were extracted and evaluated by two independent reviewers. Exclusion criteria were sample size <5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. Technical success, clinical success, 30-day rebleeding, 30-day overall and major complications, and 30-day mortality were evaluated. The estimated overall rates were calculated with their 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. Heterogeneity across studies was assessed using the Q test and I2 statistic. RESULTS Fifteen studies with 574 patients were included. For upper GIB (331 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (328 of 331 patients) and 88.0% (237 of 300 patients), and 12.5% (69 of 314 patients) and 15.9% (68 of 331 patients), respectively. Thirty-day overall and major complications occurred in 14.3% (28 of 331 patients) and 2.7% (7 of 331 patients) of patients, respectively. For lower GIB (243 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (78 of 78 patients) and 78.0% (145 of 189 patients), and 15.7% (33 of 218 patients) and 12.7% (14 of 78 patients), respectively. Thirty-day overall and major complications occurred in 13.0% (25 of 228 patients) and 8.6% (19 of 228 patients) of patients, respectively. CONCLUSION TAE with NBCA is safe and effective for treating non-variceal GIB, with high clinical success and very low major complication rates.
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Affiliation(s)
- Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Pierre-Olivier Comby
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Kevin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Thomas Mouillot
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Marc Bardou
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Serge Aho-Glélé
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France.
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10
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Park S, Jeong B, Shin JH, Jang EH, Hwang JH, Kim JH. Transarterial embolisation for gastroduodenal bleeding following endoscopic resection. Br J Radiol 2021; 94:20210062. [PMID: 33861138 DOI: 10.1259/bjr.20210062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. METHODS Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. RESULTS Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. CONCLUSIONS TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. ADVANCES IN KNOWLEDGE This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.
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Affiliation(s)
- Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, Republic of Korea
| | - Jung Han Hwang
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
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Empiric Transcatheter Embolization for Acute Arterial Upper Gastrointestinal Bleeding: A Meta-Analysis. AJR Am J Roentgenol 2021; 216:880-893. [PMID: 33566631 DOI: 10.2214/ajr.20.23151] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this study was to conduct a meta-analysis to assess the safety and efficacy of empiric embolization compared with targeted embolization in the treatment of acute upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS. We searched the PubMed and Cochrane Library databases for studies performed without language restrictions from January 2000 to November 2019. Only clinical studies with a sample size of five or more were included. Clinical success, rebleeding and complication rates, survival rates, bleeding cause, embolic materials, and vessels embolized were recorded. Empiric embolization and targeted embolization (i.e., embolization performed based on angiographic evidence of ongoing bleeding) were compared when possible. Meta-analysis was performed. RESULTS. Among 13 included studies (12 retrospective and 1 prospective), a total of 357 of 725 patients (49.2%) underwent empiric embolization for UGIB. The clinical success rate of empiric embolization was 74.7% (95% CI, 63.1-86.3%) among the 13 studies, and the survival rate was 80.9% (95% CI, 73.8-88.0%) for 10 studies. On the basis of comparative studies, no statistically significant difference was observed between empiric and targeted embolization in terms of rebleeding rate in 111 studies (36.5% vs 29.6%; odds ratio [OR], 1.13; 95% CI, 0.77-1.65; p = .53), mortality in eight studies (23.3% vs 18.0%; OR, 1.44; 95% CI, 0.89-2.33; p = .14), and need for surgery to control rebleeding in four studies (17.8% vs 13.4%; OR, 1.34; 95% CI, 0.58-3.07; p = .49). The pooled embolization-specific complications were 1.9% (empiric) and 2.4% (targeted). CONCLUSION. According to all available published evidence, empiric embolization assessed with endoscopic or preprocedural imaging findings (or both) appears to be as effective as targeted embolization in preventing rebleeding and mortality in patients with angiographically negative acute UGIB. Because of its favorable safety profile, empiric embolization should be considered for patients in this clinical scenario.
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Loffroy R, Desmyttere AS, Mouillot T, Pellegrinelli J, Facy O, Drouilllard A, Falvo N, Charles PE, Bardou M, Midulla M, Aho-Gléglé S, Chevallier O. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur Radiol 2020; 31:3015-3026. [PMID: 33128601 DOI: 10.1007/s00330-020-07427-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare our experience with N-butyl cyanoacrylate glue as the primary embolic agent versus other embolic agents for transcatheter arterial embolization (TAE) in refractory peptic ulcer bleeding and to identify factors associated with early rebleeding and 30-day mortality. METHODS Retrospective study of 148 consecutive patients comparing the clinical success rate in 78 patients managed with Glubran®2 N-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) alone or with other agents and 70 with other embolic agents only (coils, microspheres, ethylene-vinyl alcohol copolymer, or gelatin sponge) at a university center in 2008-2019. Univariate and multivariate logistic regression analyses were done to identify prognostic factors. RESULTS The technical success rate was 95.3% and the primary clinical success was 64.5%. The early rebleeding and day-30 mortality rates were 35.4% and 21.3%, respectively. Rebleeding was significantly less common with than without Glubran®2 (OR, 0.47; 95% CI, 0.22-0.99; p = .047) and significantly more common with coils used alone (OR, 20.4; 95% CI, 10.13-50.14; p = .024). The only other factor independently associated with early rebleeding was having two or more comorbidities (OR, 20.14; 95% CI, 10.01-40.52; p = .047). Day-30 mortality was similar in the two treatment groups. A lower initial hemoglobin level was significantly associated with higher day-30 mortality (OR, 10.38; 95% CI, 10.10-10.74; p = .006). Fluoroscopy time was significantly shorter with Glubran®2 (20.8 ± 11.5 min vs. 35.5 ± 23.4 min, p = .002). Both groups (Glubran®2 vs. other agents) had similar rates of overall complications (10.7% vs. 9.1%, respectively, p = .786). CONCLUSIONS Glubran®2 NBCA-MS as the primary agent allowed for faster and better clinical success compared to other embolic agents when used for TAE to safely stop refractory peptic ulcer bleeding. KEY POINTS • Choice of embolic agent for arterial embolization of refractory peptic ulcer bleeding is still debated. We compared our experience with N-butyl cyanoacrylate (NBCA) glue vs. other embolic agents. • The use of Glubran®2 NBCA glue in the endovascular management of refractory peptic ulcer bleeding was significantly faster and more effective, and at least as safe compared to other embolic agents. • NBCA glue offers several advantages compared to other embolic agents and provides rapid hemostasis when used for arterial embolization to treat refractory peptic ulcer bleeding. It should be the first-line therapy.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France. .,Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Anne-Solène Desmyttere
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Thomas Mouillot
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Antoine Drouilllard
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Pierre-Emmanuel Charles
- Department of Anesthesia and Intensive Care, François-Mitterrand University Hospital, Dijon, France
| | - Marc Bardou
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Serge Aho-Gléglé
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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Nakashima M, Shimohira M, Nagai K, Ohta K, Sawada Y, Ohba S, Nakayama K, Shibamoto Y. Embolization for acute arterial bleeding: use of the triaxial system and N-butyl-2-cyanoacrylate. MINIM INVASIV THER 2020; 31:389-395. [PMID: 33140983 DOI: 10.1080/13645706.2020.1830801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to evaluate the usefulness of transcatheter arterial embolization (TAE) using the triaxial system with N-butyl-2-cyanoacrylate (NBCA) for acute arterial bleeding in comparison to TAE using the triaxial system with gelatin sponges (GS) and/or coils. MATERIAL AND METHODS Between October 2013 and November 2018, 95 patients with acute arterial bleeding underwent emergency TAE using the triaxial system. Six patients underwent multiple TAEs and thus, 104 TAEs using the triaxial system were performed. In 26 of the 104 cases, TAE were performed with NBCA (NBCA group), and in the remaining 78 cases, TAE were performed with GS and/or coils (control group). RESULTS Hemorrhagic shock and coagulopathy more often occurred in the NBCA group. Procedure time was shorter in the NBCA group. The technical success rate was 100% in both groups (p > 0.99). The clinical success rate in the NBCA and control groups was 92% and 96%, respectively (p = 0.6). There was one minor complication (4%, 1/26) of liver dysfunction in a patient of the NBCA group, but no complication in the control group (p = 0.26). CONCLUSION TAE using the triaxial system with NBCA may be useful for acute arterial bleeding, especially in patients with hemorrhagic shock and coagulopathy.
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Affiliation(s)
- Masahiro Nakashima
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Nagai
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Shota Ohba
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keita Nakayama
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
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14
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Loffroy R, Mouillot T, Bardou M, Chevallier O. Current role of cyanoacrylate glue transcatheter embolization in the treatment of acute nonvariceal gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol 2020; 14:975-984. [PMID: 32602758 DOI: 10.1080/17474124.2020.1790355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Over the past three decades, transcatheter arterial embolization (TAE) has become the first-line therapy for the management of acute nonvariceal gastrointestinal bleeding (NVGIB) that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer liquid embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of acute NVGIB. Many embolic agents have been used successfully. However, no guidelines exist about the choice of the best embolic agent which is still controversial. Cyanoacrylate glue has gained acceptance over time. This article aims to address the current role of TAE using cyanoacrylate glue for the treatment of acute NVGIB. AREAS COVERED The authors undertook a literature review of the current evidence on the use of cyanoacrylate glue in treating patients with acute NVGIB. EXPERT OPINION The evidence shows that cyanoacrylate glue is the most clinically useful embolic agent in treating patients with acute NVGIB, despite the need for learning curve, especially in case of coagulopathy. At present, research is ongoing to assess liquid embolic agents in the treatment of patients presenting with acute NVGIB. More research is needed but cyanoacrylate glue show promise for the future.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital , Dijon, France
| | - Thomas Mouillot
- Department of Gastroenterology and Hepatology, Clinical Investigation Center, François-Mitterrand University Hospital , Dijon, France
| | - Marc Bardou
- Department of Gastroenterology and Hepatology, Clinical Investigation Center, François-Mitterrand University Hospital , Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital , Dijon, France
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15
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Kim JS, Kim BW, Kim DH, Park CH, Lee H, Joo MK, Jung DH, Chung JW, Choi HS, Baik GH, Lee JH, Song KY, Hur S. Guidelines for Nonvariceal Upper Gastrointestinal Bleeding. Gut Liver 2020; 14:560-570. [PMID: 32581203 PMCID: PMC7492499 DOI: 10.5009/gnl20154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022] Open
Abstract
Nonvariceal upper gastrointestinal bleeding (NVUGIB) refers to bleeding that develops in the gastrointestinal tract proximal to the ligament of Treitz. NVUGIB requires hospitalization and is associated with significant morbidity and mortality. Although European and Asian-Pacific guidelines have been published, there have been no previous guidelines regarding management of NVUGIB in Korea. Korea has a high prevalence of Helicobacter pylori infections, and patients have easy accessibility to endoscopy. Therefore, we believe that guidelines regarding management of NVUGIB in Korea are essential. The Korean Society of Gastroenterology reviewed the recent evidence and recommends practical management guidelines on NVUGIB in Korea.
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Affiliation(s)
- Joon Sung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyo Young Song
- Department of Surgery, College of Medicine, The Catholic University of Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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16
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Wattanasatesiri T, Chung JW, Choi TW, Kim HC, Lee M, Hur S. Shaping the tip of microcatheters for superselective catheterization: steam vs. manual methods. Diagn Interv Radiol 2020; 26:456-463. [PMID: 32673203 DOI: 10.5152/dir.2020.19314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate and compare the shapeability and stability of five microcatheters commonly used in interventional radiology after steam shaping and manual shaping. METHODS Steam shaping was performed using three mandrels of different angles: L(S) shape (90°), U(S) shape (180°), and O(S) shape (360°). Three manual shapes-L(M), U(M), and O(M)-were made to have a similar angle to their steam-shaped counterparts. The stability of the microcatheters was evaluated by passing them through a 5 F catheter and inserting microguidewires. The tip angles of the microcatheters and the angle change rates were compared between groups. RESULTS The mean angle of the microcatheters after steam shaping was 42.4°-54.1° for L(S) shape, 80.2°-96.7° for U(S) shape, and 130.7°-150.8° for O(S) shape. Five microcatheters showed significantly different mean angle reductions after passing through the 5 F catheter (17.4%-30.3%) and inserting microguidewires (24.1%-61.2%). Different microguidewires also caused significantly different mean angle reductions (34.6%-50.8%). The reduced angle caused by the guidewire was almost completely recovered after withdrawing it (93.2%-101.6%). Although manual-shaped microcatheters showed a 4.2%-6.3% greater angle reduction than steam-shaped microcatheters after passing through the 5 F catheter, the final tip angle was not significantly different between the two groups and was within 10%. CONCLUSION The tip angle of the microcatheters after steam shaping using mandrels may differ depending on the shape of the mandrel and the type of microcatheter used, and the stability varies depending on the type of microcatheter. The manual shaping of microcatheters can be a good alternative to steam shaping.
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Affiliation(s)
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Tae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
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Pech M, Serafin Z, Fischbach F, Damm R, Jargiełło T, Seidensticker M, Powerski M. Transarterial embolization of acute iatrogenic hemorrhages: predictive factors for mortality and outcome. Br J Radiol 2020; 93:20190413. [PMID: 32142365 PMCID: PMC10993211 DOI: 10.1259/bjr.20190413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Iatrogenic hemorrhages occur in 0.5-16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome. METHODS All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality. RESULTS A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% vs 15%, p < 0.05). CONCLUSION Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention. ADVANCES IN KNOWLEDGE This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.
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Affiliation(s)
- Maciej Pech
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
- Department of Radiology, Medical University of
Gdańsk, Gdańsk,
Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus
Copernicus University, Bydgoszcz,
Poland
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology,
Medical University of Lublin,
Lublin, Poland
| | - Max Seidensticker
- Department of Radiology, University Hospital
Munich, Munich,
Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
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18
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Cho SB, Hur S, Kim HC, Jae HJ, Lee M, Kim M, Kim JE, Lee JH, Chung JW. Transcatheter arterial embolization for advanced gastric cancer bleeding: A single-center experience with 58 patients. Medicine (Baltimore) 2020; 99:e19630. [PMID: 32282712 PMCID: PMC7220502 DOI: 10.1097/md.0000000000019630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers.From January 2005 to December 2014, 58 patients with pathologically proven gastric cancer were treated at our institution with transcatheter arterial embolization due to acute upper gastrointestinal bleeding recalcitrant to endoscopic treatment. The electronic medical records for each patient were reviewed for clinical presentation, endoscopy history, computed tomography and angiographic findings, blood transfusion requirements, and follow-up results.Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7-1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0-24 units) (P = .02).Transcatheter arterial embolization is a highly effective treatment for advanced gastric cancer with active bleeding. It should be considered as an additional treatment, especially when endoscopic or surgical treatment fails or when these approaches are difficult.
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Affiliation(s)
- Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul
| | - Minuk Kim
- Department of Radiology, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu
| | - Jeong-Eun Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul
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19
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Lee SM, Jeong SY, Shin JH, Choi HC, Na JB, Won JH, Park SE, Chen CS. Transcatheter arterial embolization for gastrointestinal bleeding related to pancreatic adenocarcinoma: clinical efficacy and predictors of clinical outcome. Eur J Radiol 2020; 123:108787. [PMID: 31877509 DOI: 10.1016/j.ejrad.2019.108787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/13/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the clinical efficacy of transcatheter arterial embolization (TAE) for managing pancreatic adenocarcinoma-related gastrointestinal (GI) bleeding, and to determine the factors associated with clinical outcomes. METHOD From 2001-2017, this retrospective study included 58 patients who underwent TAE for pancreatic adenocarcinoma-related GI bleeding. The technical and clinical success of TAE, clinical factors including patient characteristics and embolization details, complications, and the 30-day mortality were evaluated. Univariate analyses were performed to determine the factors related to the clinical outcomes. RESULTS On angiography, bleeding foci were detected in 47 patients (81%), while the other 11 patients showed tumor staining. Technical success rate was 98%, and first session and overall clinical success rates were 79% and 88%, respectively. N-butyl cyanoacrylate (NBCA) was the most commonly used embolic agent (53%). Stent-related bleeding was shown in 22 patients with characteristic angiogram such as arterial cut-off (13/22) and arteriobiliary fistula (5/22), with comparable clinical success rate (82%). Bleeding from the superior mesenteric artery (n = 3) at the first session of angiography and complications (n = 2), such as ischemic hepatitis and small bowel infarction, were all associated with a 30-day mortality. The overall 30-day mortality rate was 22%. Univariate analysis showed that massive transfusion and TNM stage 4 were related to clinical failure (P = 0.035 and 0.038, respectively). CONCLUSIONS TAE was effective and safe for pancreatic adenocarcinoma-related GI bleeding. Stent-related bleeding was not uncommon, and associated with vascular abnormality amenable to TAE. Massive transfusion and TNM stage 4 were related to clinical failure.
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Affiliation(s)
- Sang Min Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - So Yeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jae Boem Na
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University Hospital, Changwon, Republic of Korea
| | - Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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20
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Lee IJ. Outcomes and complications of embolization for gastrointestinal bleeding. GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- In Joon Lee
- Department of Radiology, Center for Liver Cancer, National Cancer Center, Goyang, Korea
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21
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Thamtorawat S, Nadarajan C, Rojwatcharapibarn S. Essential vascular anatomy and choice of embolic materials in gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Somrach Thamtorawat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chandran Nadarajan
- Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Satit Rojwatcharapibarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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22
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Jeong N, Kim KS, Jung YS, Kim T, Shin SM. Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage. Am J Emerg Med 2018; 37:277-280. [PMID: 29848459 DOI: 10.1016/j.ajem.2018.05.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To determine the association between delayed (>24 h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH). METHODS We retrospectively analyzed all adult patients with UGIH who underwent endoscopy in a single emergency room for 2 years. The primary exposure was defined as >24 h from the ED visit to the first endoscopy. The primary outcome was defined as all cause hospital mortality. Secondary outcomes were intensive care unit admission rate, ED length of stay, and hospital length of stay. RESULTS Among 1101 patients enrolled, 898 received endoscopy within 24 h (early group) and 203 received endoscopy after 24 h (delayed group). The hospital mortality of early and delayed group was 2.8% and 6.4%, respectively (unadjusted relative risk [RR] 2.30: 95% CI, 1.20-4.42, p = 0.012). This was significant after adjusting covariates including AIMS65 and Glasgow-Blatchford score (adjusted RR 2.23: 95% CI, 1.18-4.20, p = 0.013). Intensive care unit admission rate was not different between two groups. ED and hospital length of stay were significantly longer in delayed group. CONCLUSIONS Endoscopy performed after 24 h was associated with increased hospital mortality in UGIH. Patients in the delayed group stayed longer in the ED and in the hospital.
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Affiliation(s)
- Namkyung Jeong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Yoon Sun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Taegyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So Mi Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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