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Yu Q, Funaki B, Ahmed O. Twenty years of embolization for acute lower gastrointestinal bleeding: a meta-analysis of rebleeding and ischaemia rates. Br J Radiol 2024; 97:920-932. [PMID: 38364312 PMCID: PMC11075984 DOI: 10.1093/bjr/tqae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Transarterial embolization (TAE) for acute lower gastrointestinal bleeding (LGIB) can be technically challenging due to the compromise between achieving haemostasis and causing tissue ischaemia. The goal of the present study is to determine its technical success, rebleeding, and post-embolization ischaemia rates through meta-analysis of published literature in the last twenty years. METHODS PubMed, Embase, and Cochrane Library databases were queried. Technical success, rebleeding, and ischaemia rates were extracted. Baseline characteristics such as author, publication year, region, study design, embolization material, percentage of superselective embolization were retrieved. Subgroup analysis was performed based on publication time and embolization agent. RESULTS A total of 66 studies including 2121 patients who underwent embolization for acute LGIB were included. Endoscopic management was attempted in 34.5%. The pooled overall technical success, rebleeding, post-embolization ischaemia rates were 97.0%, 20.7%, and 7.5%, respectively. Studies published after 2010 showed higher technical success rates (97.8% vs 95.2%), lower rebleeding rates (18.6% vs 23.4%), and lower ischaemia rates (7.3% vs 9.7%). Compared to microcoils, NBCA was associated with a lower rebleeding rate (9.3% vs 20.8%) at the expense of a higher post-embolization ischaemia rate (9.7% vs 4.0%). Coagulopathy (P = .034), inotropic use (P = .040), and malignancy (P = .002) were predictors of post-embolization rebleeding. Haemorrhagic shock (P < .001), inotropic use (P = .026), malignancy (P < .001), coagulopathy (P = .002), blood transfusion (P < .001), and enteritis (P = .023) were predictors of mortality. Empiric embolization achieved a similarly durable haemostasis rate compared to targeted embolization (23.6% vs 21.1%) but a higher risk of post-embolization ischaemia (14.3% vs 4.7%). CONCLUSION For LGIB, TAE has a favourable technical success rate and low risk of post-embolization ischaemia. Its safety and efficacy profile has increased over the last decade. Compared to microcoils, NBCA seemed to offer a more durable haemostasis rate at the expense of higher ischaemia risk. Due to the heterogeneity of currently available evidence, future prospective and comparative studies are warranted. ADVANCES IN KNOWLEDGE (1) Acute LGIB embolization demonstrate a high technical success rate with acceptable rate of rebleeding and symptomatic ischaemia rates. Most ischaemic stigmata discovered during routine post-embolization colonoscopy were minor. (2) Although NBCA seemed to offer a more durable haemostasis rate, it was also associated with a higher risk of ischaemia compared to microcoils. (3) Coagulopathy, malignant aetiology, and inotropic use were predictors of rebleeding and mortality. (4) Routine post-embolization endoscopy to assess for ischaemia is not indicated.
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Affiliation(s)
- Qian Yu
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, 33331, United States
| | - Brian Funaki
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology 2024; 310:e232298. [PMID: 38441091 DOI: 10.1148/radiol.232298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high health care utilization and costs. Radiologic techniques including CT angiography, catheter angiography, CT enterography, MR enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist, which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided. © Radiological Society of North America and the American College of Gastroenterology, 2024. Supplemental material is available for this article. This article is being published concurrently in American Journal of Gastroenterology and Radiology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Citations from either journal can be used when citing this article. See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Neil Sengupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David M Kastenberg
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David H Bruining
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Melissa Latorre
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jonathan A Leighton
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Olga R Brook
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael L Wells
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Flavius F Guglielmo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Haresh V Naringrekar
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael S Gee
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jorge A Soto
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Seong Ho Park
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Don C Yoo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Vijay Ramalingam
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Alvaro Huete
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Ashish Khandelwal
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Avneesh Gupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Brian C Allen
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Mark A Anderson
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Bari R Dane
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Farnoosh Sokhandon
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David J Grand
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Justin R Tse
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jeff L Fidler
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology. Am J Gastroenterol 2024; 119:438-449. [PMID: 38857483 DOI: 10.14309/ajg.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 06/12/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.
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Affiliation(s)
- Neil Sengupta
- Department of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - David M Kastenberg
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David H Bruining
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa Latorre
- Department of Gastroenterology and Hepatology, New York University Langone Health, New York City, New York, USA
| | - Jonathan A Leighton
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jorge A Soto
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Don C Yoo
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vijay Ramalingam
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alvaro Huete
- Department of Radiology, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Avneesh Gupta
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Brian C Allen
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bari R Dane
- Department of Radiology, New York University Langone Health, New York City, New York, USA
| | - Farnoosh Sokhandon
- Department of Radiology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - David J Grand
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Justin R Tse
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Yu JH, Lee JW, Seo JY, Park JS, Park SJ, Kim SJ, Jang EJ, Park SW, Yeon JW. Factors influencing re-bleeding after trans-arterial embolization for endoscopically unmanageable peptic ulcer bleeding. Scand J Gastroenterol 2024; 59:7-15. [PMID: 37671790 DOI: 10.1080/00365521.2023.2253346] [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: 05/27/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND/AIMS Acute peptic ulcer bleeding is the most common cause of non-variceal upper gastrointestinal bleeding (NVUGIB). Endoscopic hemostasis is the standard treatment. However, various conditions complicate endoscopic hemostasis. Transarterial visceral embolization (TAE) may be helpful as a rescue therapy. This study aimed to investigate the factors associated with rebleeding after TAE. METHODS We retrospectively investigated the records of 156 patients treated with TAE between January 2007 and December 2021. Rebleeding was defined as the presence of melena, hematemesis, or hematochezia, with a fall (>2.0 g/dl) in hemoglobin level or shock after TAE. The primary outcomes were rebleeding rate and 30-day mortality. RESULTS Seventy patients with peptic ulcer bleeding were selected, and rebleeding within a month after TAE occurred in 15 patients (21.4%). Among the patients included in rebleeding group, significant increases were observed in the prevalence of thrombocytopenia (73.3% vs. 16.4%, p<.001) and ulcers >1 cm (93.3% vs 54.5%, p = .014). The mean AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score (2.3 vs 1.4, p = .009) was significantly higher in the rebleeding group. Multivariate logistic analysis revealed that thrombocytopenia (odds ratio 31.92, 95% confidence interval 6.24-270.6, p<.001) and larger ulcer size (odds ratio 27.19, 95% confidence interval 3.27-677.7, p=.010) significantly increased the risk of rebleeding after TAE. CONCLUSION TAE was effective in the treatment of patients with high-risk peptic ulcer bleeding. AIMS65 score was a significant predictor of rebleeding after TAE, and thrombocytopenia and larger ulcer size increased the risk of rebleeding after TAE.
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Affiliation(s)
- Ji Hoon Yu
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jeong Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jun-Young Seo
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Ju Sang Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Jong Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang-Jung Kim
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Eun Jeong Jang
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Woon Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Woo Yeon
- Department of Radiology, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
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Kessler J, Pham R, Pedersoli F, Ma H, Boas FE, Kidambi TD. Computed Tomography Angiography and Conventional Angiography for the Diagnosis and Treatment of Non-variceal Gastrointestinal Bleeding at a Tertiary Cancer Center. Cureus 2023; 15:e51031. [PMID: 38264383 PMCID: PMC10804205 DOI: 10.7759/cureus.51031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION To evaluate the diagnostic value of computed tomography angiography (CTA) and conventional angiography (CA) and the therapeutic value of transarterial embolization for acute gastrointestinal bleeding in patients with malignancy. METHODS A retrospective review of 100 patients who underwent CTA and/or CA for gastrointestinal bleeding at a comprehensive cancer center between the years 2011-2021 was performed. Clinical and patient outcome data were collected and analyzed using Kruskal-Wallis tests for continuous variables and chi-square tests or Fisher's exact tests (whichever is appropriate) for categorical variables in univariate analysis. All tests were two-sided at a significance level of 0.05. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). RESULTS Fifty-two percent of our patients underwent CTA alone, 29% underwent CA alone, and 19% underwent both procedures. Overall, CTA was positive in 11.3% (8/71) of patients and CA was positive in 22.9% (11/38) of patients. Of patients who underwent both studies, 52.6% (10/19) were positive for both. ICU admission was associated with CTA and/or CA positivity (p=0.015). Of 48 patients with data for embolization, 50% of patients underwent transarterial embolization for bleeding, 11 patients had identifiable bleeding on CA, and 13 patients underwent prophylactic embolization at the site of suspected bleeding. Rebleeding following embolization was found in 33.3% (8/24) of patients, including six patients who underwent prophylactic embolization and two patients who were treated for visualized bleeding. CONCLUSION CTA and CA are two critical studies for patients with GI bleeding and a history of malignancy. Neither alone can effectively exclude an identifiable source of bleeding. In patients with a history of malignancy, transarterial embolization may be an effective treatment of both angiographically visible and occult sources of GI bleeding.
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Affiliation(s)
- Jonathan Kessler
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Richard Pham
- School of Medicine, University of California Riverside School of Medicine, Riverside, USA
| | - Frederico Pedersoli
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Huiyan Ma
- Department of Epidemiology and Statistics, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - F Edward Boas
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Trilokesh D Kidambi
- Department of Medicine, Division of Gastroenterology, City of Hope Comprehensive Cancer Center, Duarte, USA
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Ini' C, Distefano G, Sanfilippo F, Castiglione DG, Falsaperla D, Giurazza F, Mosconi C, Tiralongo F, Foti PV, Palmucci S, Venturini M, Basile A. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc 2023; 6:18. [PMID: 36988839 DOI: 10.1186/s42155-023-00360-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Acute non-variceal gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. MAIN BODY Through the PubMed, Embase and Google Scholar database, an extensive search was performed in the fields of empiric and preventive embolization for the treatment of upper and lower gastrointestinal bleedings (UGIB and LGIB). Inclusion criteria were: articles in English for which it has been possible to access the entire content; adults patients treated with empiric or blind transcatheter arterial embolization (TAE) for UGIB and/or LGIB. Only studies that analysed clinical and technical success rate of blind and empiric TAE for UGIB and/or LGIB were considered for our research. Exclusion criteria were: recurrent articles from the same authors, articles written in other languages, those in which the entire content could not be accessed and that articles were not consistent to the purposes of our research. We collected pooled data on 1019 patients from 32 separate articles selected according to the inclusion and exclusion criteria. 22 studies focused on UGIB (total 773 patients), one articles focused on LGIB (total 6 patients) and 9 studies enrolled patients with both UGIB and LGIB (total 240 patients). Technical success rate varied from 62% to 100%, with a mean value of 97.7%; clinical success rate varied from 51% to 100% with a mean value of 80%. The total number of complications was 57 events out of 1019 procedures analysed. CONCLUSION TAE is an effective procedure in the treatment of UGIB patients in which angiography does not demonstrate direct sign of ongoing bleeding. The attitude in the treatment of LGIBs must be more prudent in relation to poor vascular anastomoses and the high risk of intestinal ischemia. Blind and preventive procedures cumulatively present a relatively low risk of complications, compared to a relatively high technical and clinical success.
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Affiliation(s)
- Corrado Ini'
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giulio Distefano
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Davide Giuseppe Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Viale Luigi Borri 57, 21100, Varese, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Szmygin M, Szmygin P, Drelich K, Pustelniak O, Pech M, Jargiełło T. The role of interventional radiology in treatment of patients with hereditary hemorrhagic telangiectasia. Eur J Radiol 2023; 162:110769. [PMID: 36933496 DOI: 10.1016/j.ejrad.2023.110769] [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: 10/19/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu disease is a rare autosomal dominant, multi-organ disorder that leads to formation of abnormal vascular connections resulting in devastating and life-threatening complications. Due to its multisystem character, wide range of clinical manifestations and variable expressivity, HHT remains a diagnostic challenge and requires close cooperation of specialists from various medical fields. Interventional radiology plays a key role in the management of this disease, helping maintain the health of HHT patients and minimize the risk of fatal complications. The aim of this article is to review clinical manifestations, diagnostic guidelines and criteria of HHT as well as to present the means of endovascular therapy in the management of HHT patients.
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Affiliation(s)
- Maciej Szmygin
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Poland.
| | - Paweł Szmygin
- Medical University of Lublin, Department of Neurosurgery, Lublin, Poland
| | - Katarzyna Drelich
- Medical University of Lublin, Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Lublin, Poland
| | - Olga Pustelniak
- Medical University of Lublin, Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Lublin, Poland
| | - Maciej Pech
- Medical University of Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg, Germany
| | - Tomasz Jargiełło
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Poland
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Shidahara H, Fujikuni N, Tanabe K, Abe T, Nishihara K, Noriyuki T, Nakahara M. Massive bleeding from gastric ulcer-induced splenic artery pseudoaneurysm successfully treated with transcatheter arterial embolization and surgery: a case report. Surg Case Rep 2022; 8:196. [PMID: 36219275 PMCID: PMC9554172 DOI: 10.1186/s40792-022-01552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a routine medical emergency. The most common non-variceal cause is peptic ulcer disease, while a rare presentation is peptic ulcer-induced splenic artery pseudoaneurysm (SAP). Primary endoscopic treatment is generally attempted for UGIB; however, it sometimes fails when arterial etiology is present. In such cases, either transcatheter arterial embolization (TAE) or surgery is necessary, but the choice of treatment is controversial. We present a case that illustrates the utility of both approaches in a gastric ulcer-induced SAP. CASE PRESENTATION A 33-year-old male presented with hemorrhagic shock secondary to UGIB. The source of bleeding was identified as an SAP that was caused by a gastric ulcer. TAE enabled temporary bleeding control despite the patient's poor overall condition and limited blood transfusion capability. However, rebleeding occurred soon after stabilization. Ultimately, we performed proximal gastrectomy and splenic artery ligation, and the patient survived. CONCLUSIONS SAP is an uncommon occurrence, and angiographic information is important for correctly identifying the source of bleeding. The treatment for SAP bleeding is basically the same as for endoscopically unmanageable non-variceal UGIB, since TAE and surgery each have a different utility, depending on the situation. If surgery is performed, especially SA ligation and gastrectomy, it is important to consider the circulation of the spleen and residual stomach. Using TAE and laparotomy, we managed to save the life of the patient with massive hemorrhage under limited circumstances.
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Affiliation(s)
- Hidetoshi Shidahara
- grid.416874.80000 0004 0604 7643Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima Japan ,grid.257022.00000 0000 8711 3200Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Fujikuni
- grid.416874.80000 0004 0604 7643Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima Japan ,grid.414173.40000 0000 9368 0105Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuaki Tanabe
- grid.257022.00000 0000 8711 3200Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Abe
- grid.416874.80000 0004 0604 7643Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima Japan
| | - Keisuke Nishihara
- grid.416874.80000 0004 0604 7643Department of Radiology, Onomichi General Hospital, Onomichi, Hiroshima Japan
| | - Toshio Noriyuki
- grid.416874.80000 0004 0604 7643Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima Japan
| | - Masahiro Nakahara
- grid.416874.80000 0004 0604 7643Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima Japan
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Min X, Feng Z, Gao J, Chen S, Zhang P, Fu T, Shen H, Wang N. InterNet: Detection of Active Abdominal Arterial Bleeding Using Emergency Digital Subtraction Angiography Imaging With Two-Stage Deep Learning. Front Med (Lausanne) 2022; 9:762091. [PMID: 35847818 PMCID: PMC9276930 DOI: 10.3389/fmed.2022.762091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Active abdominal arterial bleeding is an emergency medical condition. Herein, we present our use of this two-stage InterNet model for detection of active abdominal arterial bleeding using emergency DSA imaging. Methods Firstly, 450 patients who underwent abdominal DSA procedures were randomly selected for development of the region localization stage (RLS). Secondly, 160 consecutive patients with active abdominal arterial bleeding were included for development of the bleeding site detection stage (BSDS) and InterNet (cascade network of RLS and BSDS). Another 50 patients that ruled out active abdominal arterial bleeding were used as negative samples to evaluate InterNet performance. We evaluated the mode's efficacy using the precision-recall (PR) curve. The classification performance of a doctor with and without InterNet was evaluated using a receiver operating characteristic (ROC) curve analysis. Results The AP, precision, and recall of the RLS were 0.99, 0.95, and 0.99 in the validation dataset, respectively. Our InterNet reached a recall of 0.7, the precision for detection of bleeding sites was 53% in the evaluation set. The AUCs of doctors with and without InterNet were 0.803 and 0.759, respectively. In addition, the doctor with InterNet assistant could significantly reduce the elapsed time for the interpretation of each DSA sequence from 84.88 to 43.78 s. Conclusion Our InterNet system could assist interventional radiologists in identifying bleeding foci quickly and may improve the workflow of the DSA operation to a more real-time procedure.
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Affiliation(s)
- Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoyan Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junfeng Gao
- College of Biomedical Engineering, South-Central of University for Nationalities, Wuhan, China
| | - Shu Chen
- United Imaging Intelligence, Shanghai, China
| | - Peipei Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Fu
- United Imaging Intelligence, Shanghai, China
| | - Hong Shen
- United Imaging Intelligence, Shanghai, China
| | - Nan Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Nan Wang
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10
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Li MF, Liang HL, Chiang CL, Lin YH. Management of acute lower gastrointestinal bleeding by pharmaco-induced vasospasm embolization therapy. J Chin Med Assoc 2022; 85:233-239. [PMID: 35175244 DOI: 10.1097/jcma.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To report the clinical outcomes of vasospasm embolization technique in treating lower gastrointestinal bleeding (LGIB). METHODS Fifty LGIB patients (32 men and 18 women; mean age, 70.4 years) with positive contrast extravasation on multidetector computed tomography were treated with pharmaco-induced vasospasm embolization by semiselective catheterization technique. Distal rectal bleeding was excluded. The bleedings in three patients were considered to be tumor related. Eighteen underwent regular hemodialysis, and 22 showed unstable hemodynamic at intervention. RESULTS Forty-two bleeders were found in superior mesenteric territory and eight in the inferior mesenteric territory. Successful, immediate hemostasis was achieved in 49 (98%) patients. Early recurrent bleeding (<30 days) was found in 13 (26.5%) patients with 6 local rebleeding (12.2%), 5 new-foci bleeding (10.2%), and 2 uncertain foci bleeding (4.1%). Repeated vasospasm embolization therapy was given to five patients, with successful hemostasis in four. All the three tumor-related bleeding patients undergoing vasospasm embolization had ceased bleeding and discharged. Patient-based primary and overall clinical successes were achieved in 73.5% and 83.7%, and lesion-based primary and overall clinical successes were 83.0% and 86.7%, respectively. The 30-day mortality rate was 21.3%, and the 1- and 2-year survival rates were 51.5% and 43.8%. No major procedure-related complications (eg, bowel ischemia) were encountered. CONCLUSION This study confirmed our prior preliminary conclusion that pharmaco-induced vasospasm embolization is easy, safe, and effective for LGIB. This treatment may be considered the first-line alternative approach for LGIB, especially for patients of advanced age with complex medical problems and/or when vasa rectal embolization isn't feasible.
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Affiliation(s)
- Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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11
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Lee HN, Cho Y, Lee S, Park SJ. Value of multiphase computed tomography for gastrointestinal bleeding before endovascular treatment in hemodynamically unstable patients. Acta Radiol 2022; 64:58-66. [PMID: 35084248 DOI: 10.1177/02841851221074579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There has been no practice-based study regarding the multiphase computed tomography (CT) before endovascular treatment in hemodynamically unstable gastrointestinal bleeding (GIB) and concerns exist regarding the time delay. PURPOSE To evaluate the clinical efficacy of multiphase CT before endovascular treatment in hemodynamically unstable GIB and to investigate the predictors of angiographic localization and recurrent bleeding. MATERIAL AND METHODS The multicenter retrospective study included 93 consecutive hemodynamically unstable patients who underwent conventional angiography for non-variceal GIB after failed endoscopic localization. Enrolled patients were divided into a CT group (n = 61) and a non-CT group (n = 32). RESULTS The clinical characteristics did not differ between the two groups except for the time to angiography (CT group, 14.8±15.1 h; non-CT group, 9.2±11.7 h, P = 0.022). The rate of angiographic localization was significantly higher in the CT group than in the non-CT group only for lower GIB (P = 0.049). Indirect sign was significantly more frequent in the CT group than in the non-CT group (P = 0.014). CT localization was positive predictor (odd ratio [OR] = 7.66; 95% confidence interval [CI] = 2.1-27.94; P = 0.002) and prolonged time to angiography was negative predictor (OR = 0.94; 95% CI = 0.9- 0.98; P = 0.001) for angiographic localization. A higher systolic blood pressure until index angiography (OR = 0.95; 95% CI = 0.91-1; P = 0.044) was associated with a reduced risk of recurrent bleeding. CONCLUSION In hemodynamically unstable patients, multiphase CT is particularly useful for angiographic localization of lower GIB. It should be considered immediately after failed endoscopic hemostasis to reduce time to angiography.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| | - Youngjong Cho
- Department of Radiology, Gangneung Asan Hospital, Gangneung-si, Republic of Korea
| | - Sangjoon Lee
- Department of Radiology, Pohang St Mary’s Hospital, Pohang-si, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Republic of Korea
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12
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Kim YS, Kwon JH, Han K, Kim MD, Lee J, Kim GM, Won JY. Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications. Acta Radiol 2021; 62:574-583. [PMID: 32586121 DOI: 10.1177/0284185120936258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. PURPOSE To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. MATERIAL AND METHODS From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. RESULTS The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). CONCLUSION TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.
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Affiliation(s)
- Yong Seek Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, Incheon, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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13
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Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding. Eur Radiol 2020; 31:2161-2172. [PMID: 32964336 DOI: 10.1007/s00330-020-07232-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/17/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the clinical effect and safety of cone-beam CT (CBCT)-guided empirical embolization for acute lower gastrointestinal bleeding (LGIB) in patients with a positive CT angiography (CTA) but subsequent negative digital subtraction angiography (DSA). METHODS A retrospective study of consecutive LGIB patients with a positive CTA who received a DSA within 24 h from January 2008 to July 2019. Patients with a positive DSA were treated with targeted embolization (TE group). Patients with a negative DSA underwent an empiric CBCT-guided embolization of the assumed ruptured vas rectum (EE group) or no embolization (NE group). Recurrent bleeding, major ischemic complications, and in-hospital mortality were compared by means of Fisher's exact test. Further subgroup analysis was performed on hemodynamic instability. RESULTS Eighty-five patients (67.6 years ± 15.7, 52 men) were included (TE group, n = 47; EE group, n = 19; NE group, n = 19). If DSA was positive, technical success of targeted embolization was 100% (47/47). If DSA was negative and the intention to treat by empiric CBCT-guided embolization, technical success was 100% (19/19). Recurrent bleeding rates in the TE group, EE group, and NE group were 17.0% (8/47), 21.1% (4/19), and 52.6% (10/19) respectively. Empiric CBCT-guided embolization reduced rebleeding significantly in patients with a negative DSA and hemodynamic instability (EE group, 3/10 vs NE group, 10/12, p = .027). Major ischemic complications occurred in one patient (TE group). Overall, the in-hospital mortality rate was 7.1% (6/85). CONCLUSION Empiric cone-beam CT-guided embolization proved to be a feasible, effective, and safe treatment strategy to reduce rebleeding and improve clinical success in hemodynamically unstable patients with acute LGIB, positive CTA but negative DSA. KEY POINTS • A novel transarterial embolization technique guided by cone-beam CT could be developed extending the "empiric" embolization strategy to lower gastrointestinal bleeding. • By implementing the empiric treatment strategy, nearly all patients with an active lower gastrointestinal bleeding on CTA will be eligible for a superselective empiric embolization, even if subsequent catheter angiography is negative. • In patients with a negative catheter angiography, empiric embolization reduces the rebleeding rate and, particularly in hemodynamically unstable patients, improves clinical success compared with a conservative "wait-and-see" management.
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14
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Miyakuni Y, Nakajima M, Ohbe H, Sasabuchi Y, Kaszynski RH, Ishimaru M, Matsui H, Fushimi K, Yamaguchi Y, Yasunaga H. Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study. Acute Med Surg 2020; 7:e533. [PMID: 32617165 PMCID: PMC7326725 DOI: 10.1002/ams2.533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 01/17/2023] Open
Abstract
Aim Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non‐endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy. Methods We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in‐hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score‐matched analyses were undertaken to adjust for confounders. Results We identified 6,546 eligible patients. The patients were divided into the colonoscopy group (n = 5,737) and angiography group (n = 809). After one‐to‐four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in‐hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group. Conclusions The present study revealed that in‐hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.
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Affiliation(s)
- Yasuhiko Miyakuni
- Department of Trauma and Critical Care Medicine School of Medicine Kyorin University Tokyo Japan
| | - Mikio Nakajima
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan.,Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | | | - Richard H Kaszynski
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Tokyo Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine School of Medicine Kyorin University Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
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15
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Wilhelm P, Stierle D, Rolinger J, Falch C, Drews U, Kirschniak A. Endoscopic projection of the gastroduodenal artery: Anatomical implications for bleeding management. Ann Anat 2020; 232:151560. [PMID: 32565392 DOI: 10.1016/j.aanat.2020.151560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Peptic ulcers account for 50% of upper gastrointestinal bleeding incidents. Bleedings from large vessels, such as the gastroduodenal artery, are associated with increased mortality. Ulcers located on the posterior wall of the duodenum show the highest risk for erosion of the gastroduodenal artery. Endoscopic management is challenging and rebleeding rates are high due to internal and external confounding factors such as anatomical variability and gastric insufflation. We aimed to correlate macroscopic and endoscopic anatomy for assessment of implications for clinical management. MATERIAL AND METHODS The gastroduodenal artery was dissected in 10 anatomical specimens. The points of contact of the artery with the posterior wall of the duodenum were marked with needles. The endoluminal position of the needles was recorded by standardized gastroscopy and a 3-dimensional virtual reconstruction was carried out for visualization of the artery's course. RESULTS The artery's proximal and distal points of contact with the duodenum were 27.2mm (range 15-30mm; SD 6.7mm) and 15mm (range 10-20mm; SD 3.5mm), respectively, from the pylorus. The gastroduodenal artery branches from the common hepatic artery within the omentum minus running adjacent to the duodenal wall to the head of the pancreas. From endoscopic perspective, the gastroduodenal artery's course was directed towards the tip of the gastroscope. CONCLUSION Due to the peculiar extraluminal course of the gastroduodenal artery the arterial blood flow projects into the direction of the gastroscope during endoscopic intervention. Measures for bleeding control might have to be applied aboral from the bleeding site.
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Affiliation(s)
- P Wilhelm
- University Clinic for Visceral, General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - D Stierle
- Albertinen Hospital, Hamburg, Germany
| | - J Rolinger
- University Clinic for Visceral, General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - C Falch
- University Clinic for Visceral, General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - U Drews
- Institute for Clinical Anatomy, Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - A Kirschniak
- University Clinic for Visceral, General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.
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16
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Leshen M, Hubert J, Cantos A. Pediatric cystic artery pseudoaneurysm embolization. Clin Imaging 2020; 61:80-83. [PMID: 31982705 DOI: 10.1016/j.clinimag.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022]
Abstract
Cystic artery pseudoaneurysm is an exceedingly rare complication of biliary interventions, such as cholecystectomy, or cholecystitis [1]. Prompt intervention is often required due to their predisposition to bleeding. Ideal diagnosis and treatment would have the patient go directly to Interventional Radiology for angiography and embolization, followed by a short interval cholecystectomy [2, 3]. However, due to their low incidence patients often undergo several less invasive diagnostic tests prior to diagnosis [4]. Here we describe what we believe is the first reported pediatric case of a cystic artery pseudoaneurysm secondary to cholecystitis.
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Affiliation(s)
- Michael Leshen
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jessica Hubert
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Andrew Cantos
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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17
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Nouri Y, Shin JH, Ko HK, Kim JW, Yoon HK. Embolization of procedure-related upper gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii170028] [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: 12/22/2022] Open
Affiliation(s)
- Yasir Nouri
- 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
| | - Heung-Kyu Ko
- 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
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Muhammad A, Awais M, Sayani R, Saeed MA, Qamar S, Rehman A, Baloch NU. Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center. Cureus 2019; 11:e4228. [PMID: 31123650 PMCID: PMC6510562 DOI: 10.7759/cureus.4228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose In patients with massive or recurrent gastrointestinal bleeding (GIB) which is not amenable to endoscopic therapy, angiographic interventions are often employed. We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent GIB. Methods All patients who had undergone empiric TAE at our hospital between March 2004 and June 2015 were identified using the institutional radiology information system. A retrospective chart review was performed using a structured pro forma. Technical success rate, 30-day clinical success rate, 30-day mortality rate, and rate of procedural complications were computed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results A total of 32 patients had undergone empiric TAE for GIB during the study period. The median age of subjects was 56 years and two-thirds of them were male (68.7%). Gastroduodenal (n=24), ileocolic (n=3), left gastric (n=2), right gastroepiploic (n=1), and branches of superior and middle rectal arteries (n=1) were embolized using microcoils (n=25), polyvinyl alcohol particles (n=25), and gelatin sponge (n=3)--either alone or in combination. Technical and 30-day clinical success rates were 96.9% (31/32) and 71.9% (23/32), respectively. The 30-day mortality rate for our cohort was 21.9% (7/32). One patient developed re-bleeding at two days after the initial procedure and required repeat embolization. Coil migration (n=3) and access site hematoma (n=1) were the observed procedural complications. Conclusion Empiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.
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Affiliation(s)
| | | | - Raza Sayani
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Saqib Qamar
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Abdul Rehman
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
| | - Noor U Baloch
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
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Tarasconi A, Baiocchi GL, Pattonieri V, Perrone G, Abongwa HK, Molfino S, Portolani N, Sartelli M, Di Saverio S, Heyer A, Ansaloni L, Coccolini F, Catena F. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg 2019; 14:3. [PMID: 30733822 PMCID: PMC6359767 DOI: 10.1186/s13017-019-0223-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022] Open
Abstract
Background Nowadays, very few patients with non-variceal upper gastrointestinal bleeding fail endoscopic hemostasis (refractory NVUGIB). This subset of patients poses a clinical dilemma: should they be operated on or referred to transcatheter arterial embolization (TAE)? Objectives To carry out a systematic review of the literature and to perform a meta-analysis of studies that directly compare TAE and surgery in patients with refractory NVUGIB. Materials and methods We searched PubMed, Ovid MEDLINE, and Embase. A combination of the MeSH terms “gastrointestinal bleeding”; “gastrointestinal hemorrhage”; “embolization”; “embolization, therapeutic”; and “surgery” were used ((“gastrointestinal bleeding” or “gastrointestinal hemorrhage”) and (“embolization” or “embolization, therapeutic”) and “surgery”)). The search was performed in June 2018. Studies were retrieved and relevant studies were identified after reading the study title and abstract. Bibliographies of the selected studies were also examined. Statistical analysis was performed using RevMan software. Outcomes considered were all-cause mortality, rebleeding rate, complication rate, and the need for further intervention. Results Eight hundred fifty-six abstracts were found. Only 13 studies were included for a total of 1077 patients (TAE group 427, surgery group 650). All selected papers were non-randomized studies: ten were single-center and two were double-center retrospective comparative studies, while only one was a multicenter prospective cohort study. No comparative randomized clinical trial is reported in the literature. Mortality. Pooled data (1077 patients) showed a tendency toward improved mortality rates after TAE, but this trend was not statistically significant (OD = 0.77; 95% CI 0.50, 1.18; P = 0.05; I2 = 43% [random effects]). Significant heterogeneity was found among the studies. Rebleeding rate. Pooled data (865 patients, 211 events) showed that the incidence of rebleeding was significantly higher for patients undergoing TAE (OD = 2.44; 95% CI 1.77, 3.36; P = 0.41; I2 = 4% [fixed effects]). Complication rate. Pooling of the data (487 patients, 206 events) showed a sharp reduction of complications after TAE when compared with surgery (OD = 0.45; 95% CI 0.30, 0.47; P = 0.24; I2 = 26% [fixed effects]). Need for further intervention. Pooled data (698 patients, 165 events) revealed a significant reduction of further intervention in the surgery group (OD = 2.13; 95% CI 1.21, 3.77; P = 0.02; I2 = 56% [random effects]). A great degree of heterogeneity was found among the studies. Conclusions The present study shows that TAE is a safe and effective procedure; when compared to surgery, TAE exhibits a higher rebleeding rate, but this tendency does not affect the clinical outcome as shown by the comparison of mortality rates (slight drift toward lower mortality for patients undergoing TAE). The present study suggests that TAE could be a viable option for the first-line therapy of refractory NVUGIB and sets the foundation for the design of future randomized clinical trials. Limitations The retrospective nature of the majority of included studies leads to selection bias. Furthermore, the decision of whether to proceed with surgery or refer to TAE was made on a case-by-case basis by each attending surgeon. Thus, external validity is low. Another limitation involves the variability in etiology of the refractory bleeding. TAE techniques and surgical procedure also differ consistently between different studies. Frame time for mortality detection differs between the studies. These limitations do not impair the power of the present study that represents the largest and most recent meta-analysis currently available.
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Affiliation(s)
- Antonio Tarasconi
- 1Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Gian Luca Baiocchi
- 2Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Vittoria Pattonieri
- 1Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Gennaro Perrone
- 1Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Hariscine Keng Abongwa
- 1Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Sarah Molfino
- 2Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- 2Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | | | - Salomone Di Saverio
- 4Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arianna Heyer
- 5Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Luca Ansaloni
- 6General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- 6General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- 1Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
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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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Powerski M, Meyer-Wilmes P, Omari J, Damm R, Seidensticker M, Friebe B, Fischbach F, Pech M. Transcatheter arterial embolization of acute bleeding as 24/7 service: predictors of outcome and mortality. Br J Radiol 2018; 91:20180516. [PMID: 30102552 DOI: 10.1259/bjr.20180516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To analyze times of occurrence and identify risk factors (RFs) for technical and clinical failure and mortality of transcatheter arterial embolization (TAE) of acute bleeding in a major hospital. METHODS All TAEs performed at our hospital from 2006 to 2013 (n = 327) were retrospectively analyzed. RESULTS TAEs were performed during regular weekday hours in 165 (50%) and during off-hours in 162 (50%) cases. With 40 regular and 128 off-hours/week, 3.25 times more TAEs were performed during regular hours. There was an even distribution across weekdays (Mon-Fri:16.9 ± 1.5%), while fewer TAEs were performed on weekends (Sat: 8.3%, Sun: 7.3%). Technical success of TAEs was 93.9% with a clinical success of 79.2% and a 30-day mortality of 18.4%. Shock was an RF for technical failure (p = 0.022). RFs for clinical failure were low hemoglobin (Hb) (p = 0.021) and transfusion of ≥6 units packed cells (p = 0.009). Independent RFs for mortality were clinical failure (p < 0.001), coagulopathy (p = 0.005), and shock (p < 0.001). CONCLUSION Our results provide no evidence for a subjectively perceived increase in TAEs during off-hours but rather appear to show that most TAEs are performed during regular hours. Prompt TAE to control acute bleeding is crucial to prevent a drop in Hb with shock and the need for transfusion, which may promote coagulopathy and rebleeding, all of which are risk factors for a negative outcome. ADVANCES IN KNOWLEDGE The presented analysis provides insights of occurrences and risk factors for success of transcatheter arterial embolization in acute bleeding in a large study population.
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Affiliation(s)
- Maciej Powerski
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Philipp Meyer-Wilmes
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Jazan Omari
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Robert Damm
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Max Seidensticker
- 2 Klinik und Poliklinik für Radiologie, Klinikum der Universität München , München , Germany
| | - Björn Friebe
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Frank Fischbach
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Maciej Pech
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany.,3 Department of Radiology, Medical University of Gdansk , Gdańsk , Poland
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22
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Lee NJ, Shin JH, Lee SS, Park DH, Lee SK, Yoon HK. Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage. Diagn Interv Imaging 2018; 99:717-724. [PMID: 30033142 DOI: 10.1016/j.diii.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE). PATIENTS AND METHODS We performed a 9-year retrospective analysis of 797 EUS-TPBD procedures (excluding gallbladder or pseudocysts) in 729 patients. Among them, twelve (12/729, 1.65%) patients were referred for TAE to manage active bleeding adjacent to the TPBD sites. There were 8 men and 4 women with a mean age of 66.1 years±13.4 (SD) (range: 45-89 years). The clinical and procedure data of these 12 patients were reviewed. RESULTS Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n=7), the right hepatic artery (n=3), the left gastric artery (n=1), the left accessory gastric artery (n=1) and gastroduodenal artery (n=1). TAE was performed with gelatin sponge particles (n=1), coil (n=1) and n-butyl-2 cyanoacrylate with/without coils (n=11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement. CONCLUSION On the basis of our results, TAE using n-butyl-2 cyanoacrylate seems safe and effective for the treatment of bleeding after EUS-TPBD procedures. When the portal vein is compromised, TAE of the hepatic artery can cause ischemic liver damage.
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Affiliation(s)
- N J Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - J H Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - S S Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - D H Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S K Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H-K Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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23
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Kwon JH, Kim MD, Han K, Choi W, Kim YS, Lee J, Kim GM, Won JY, Lee DY. Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study. Eur Radiol 2018; 29:57-67. [PMID: 29926205 DOI: 10.1007/s00330-018-5587-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/25/2018] [Accepted: 06/04/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of transcatheter arterial embolisation (TAE) in the management of lower gastrointestinal bleeding (LGIB) and to identify predictors of clinical outcomes. METHODS Between December 2005 and April 2017, 274 patients underwent diagnostic angiography for signs and symptoms of LGIB; 134 patients with positive angiographic findings were retrospectively analysed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analysed. Predictors for clinical outcomes were evaluated using univariate and multivariate logistic regression analyses. RESULTS A total of 134 patients (mean age, 59.7 years; range, 14-82 years) underwent TAE for LGIB. The bleeding foci were in the small bowel in 74 patients (55.2%), colon in 35 (26.1%), and rectum in 25 (18.7%). Technical success was achieved in 127 patients (94.8%). The clinical success rate was 63% (80/127). The rates of recurrent bleeding, major complications, and in-hospital mortality were 27.9% (31/111), 18.5% (23/124), and 23.6% (33/127), respectively. Superselective embolisation and the use of N-butyl cyanoacrylate (NBCA) were significant prognostic factors associated with reduced recurrent bleeding (OR, 0.258; p = 0.004 for superselective embolisation, OR, 0.313; p = 0.01 for NBCA) and fewer major complications (OR, 0.087; p ˂ 0.001 for superselective embolisation, OR, 0.272; p = 0.007 for NBCA). CONCLUSIONS TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent. KEY POINTS • Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage. • Superselective embolisation is essential to improve outcomes. • N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes.
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Affiliation(s)
- Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Woosun Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Yong Seek Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
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24
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Kaminskis A, Ivanova P, Ponomarjova S, Mukans M, Boka V, Pupelis G. Rockall Score Larger Than 7 as a Reliable Criterion for the Selection of Indications for Preventive Transarterial Embolization in a Subgroup of High-Risk Elderly Patients After Primary Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding. Gastroenterology Res 2018; 10:339-346. [PMID: 29317941 PMCID: PMC5755635 DOI: 10.14740/gr909w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022] Open
Abstract
Background Transarterial embolization (TAE) is an alternative procedure to repeat endoscopy or surgical intervention in the case of re-bleeding after primary endoscopic treatment. The aim of the study was to assess the Rockall score as a criterion for TAE in the case of re-bleeding after endoscopic treatment of non-variceal upper gastrointestinal bleeding (NVUGIB). Methods Out of the 673 patients who underwent emergent endoscopic hemostasis due to NVUGIB, 111 had a high risk of re-bleeding having a Forrest I-IIb ulcer and the Rockall score ≥ 5. From 111 patients, 37 accepted preventive TAE (PE+ group). The control group consisted of 74 patients who underwent standard treatment (PE- group). Results There were no differences in the demographic status between both groups, nor in the main clinical data on admission. The performance of TAE resulted in a significantly lower re-bleeding rate (1 (4.8%) vs. 11 (33%), P = 0.018). No patient who underwent TAE with the Rockall score ≥ 7 required surgery, resulting in only one re-bleeding episode (P = 0.004). Mortality reached 5% and 11% in the PE+ and PE- groups accordingly. Conclusion The Rockall score ≥ 7 could be a reliable predictor of re-bleeding after primary endoscopic hemostasis as one criterion for the selection of indications for preventive TAE.
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Affiliation(s)
- Aleksejs Kaminskis
- Department of General and Emergency Surgery, Riga East University Hospital, Riga, Latvia
| | - Patricija Ivanova
- Department of Interventional Radiology, Riga East University Hospital, Riga, Latvia
| | - Sanita Ponomarjova
- Department of Interventional Radiology, Riga East University Hospital, Riga, Latvia
| | - Maksims Mukans
- Statistical Unit, Riga Stradins University, Riga, Latvia
| | | | - Guntars Pupelis
- Surgical Department, Riga East University Hospital, Riga, Latvia
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25
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Konecki D, Grabowska-Derlatka L, Pacho R, Rowiński O. Correlation Between Findings of Multislice Helical Computed Tomography (CT), Endoscopic Examinations, Endovascular Procedures, and Surgery in Patients with Symptoms of Acute Gastrointestinal Bleeding. Pol J Radiol 2017; 82:676-684. [PMID: 29662594 PMCID: PMC5894035 DOI: 10.12659/pjr.902331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. Material/Methods The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. Results The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. Conclusions CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.
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Affiliation(s)
- Dariusz Konecki
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Ryszard Pacho
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
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26
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Efficacy and safety of superselective trans-catheter arterial embolization of upper and lower gastrointestinal bleeding using N-butyl-2-cyanoacrylate. Emerg Radiol 2017; 25:111-120. [DOI: 10.1007/s10140-017-1552-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/07/2017] [Indexed: 02/06/2023]
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27
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Hur S, Jae HJ, Lee H, Lee M, Kim HC, Chung JW. Superselective Embolization for Arterial Upper Gastrointestinal Bleeding Using N-Butyl Cyanoacrylate: A Single-Center Experience in 152 Patients. J Vasc Interv Radiol 2017; 28:1673-1680. [PMID: 28935474 DOI: 10.1016/j.jvir.2017.07.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate 30-day safety and efficacy of superselective embolization for arterial upper gastrointestinal bleeding (UGIB) using N-butyl cyanoacrylate (NBCA). MATERIALS AND METHODS This single-center retrospective 10-year study included 152 consecutive patients with UGIB (gastric, n = 74; duodenal, n = 78) who underwent embolization with NBCA for angiographically positive arterial bleeding. The primary endpoint was clinical success rate defined as achievement of hemostasis without rebleeding or UGIB-related mortality within 30 days after embolization. Mean systolic blood pressure and heart rate were 121.2 mm Hg ± 27.4 and 97.9 beats/minute ± 22.5; 31.1% of patients needed intravenous inotropes, and 36.6% had coagulopathy. The etiology of bleeding was ulcer (80.3%) or iatrogenic injury (19.7%). Statistical analysis was performed to identify predictive factors for outcomes. RESULTS Technical success rate was 100%. Clinical success, 1-month mortality, and major complication rates were 70.4%, 22.4%, and 0.7%. There were significant differences in the clinical success rates between gastric and duodenal bleeding (79.4% vs 62.2%; P = .025). The need for intravenous inotropes at the time of embolization was a significant negative predictive factor in both gastric (odds ratio [OR] = 0.091, P = .004) and duodenal (OR = 0.156, P = .002) bleeding. The use of a microcatheter with a smaller tip (2 F) was associated with better outcomes in duodenal bleeding (OR = 7.389, P = .005). CONCLUSIONS Superselective embolization using NBCA is safe and effective for angiographically positive arterial UGIB.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea.
| | - Hyukjoon Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea
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28
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Kim MJ, Oh JY, Park YS. Availability of angiography and therapeutic embolization for the treatment of acute bleeding in patients with hemophilia. Int J Hematol 2017; 106:787-793. [PMID: 28815418 DOI: 10.1007/s12185-017-2312-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
Clotting factor replacement therapy alone is often inadequate for acute bleeding in hemophilia patients, and surgery for such patients poses significant clinical challenges. Arterial angiographic intervention is used to control bleeding in local blood vessels. In the present study, we examined the clinical course and prognosis of hemophilia patients with bleeding who had undergone angiography, and evaluated the validity of diagnostic angiography and therapeutic embolization in these patients. Angiography was performed in five hemophilia patients, who experienced bleeding that was difficult to control even after treatment with clotting factor replacement or bypassing agent therapy. Of these patients, four were confirmed to have continued bleeding, and angiographic embolization was performed using clotting factor concentrates or bypassing agents. However, one patient developed uncontrollable bleeding at the puncture site, which eventually led to the patient's death. Thus, angiography and therapeutic embolization may be the preferred procedures for the treatment of hemorrhagic complications, refractory to treatment with clotting factor concentrates or bypassing agents. Further comprehensive, multidisciplinary team studies are needed to develop effective strategies to reduce hemorrhagic complications.
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Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-Gu, Seoul, 05278, Korea
| | - Ji Young Oh
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-Gu, Seoul, 05278, Korea.
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Bua-Ngam C, Norasetsingh J, Treesit T, Wedsart B, Chansanti O, Tapaneeyakorn J, Panpikoon T, Vallibhakara SAO. Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding: A single-center experience. Diagn Interv Imaging 2017; 98:499-505. [PMID: 28341118 DOI: 10.1016/j.diii.2017.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to assess the safety and efficacy of transcatheter arterial embolization (TAE) in the treatment of acute lower gastrointestinal bleeding (LGIB) and to determine the potential factors that influence treatment outcome. MATERIAL AND METHODS A total of 38 patients with acute LGIB who were treated by TAE were retrospectively included. There were 24 men and 14 women, with a mean age of 61 years (range: 9-84 years). Patient characteristics, laboratory findings, treatments, causes of bleeding, angiographic findings, and outcomes were reviewed. RESULTS Active contrast extravasation was observed in 26/38 patients (68.4%) and was the most frequent angiographic finding, followed by abnormal mucosal staining (8/38; 21.1%) and tumor staining (4/38; 10.5%). Technical success of TAE was obtained in 35/38 patients (92%) whereas technical failure was observed in 3/38 patients (8%). Clinical success rate following TAE was 63%. Bowel ischemia occurred in 5/38 patients (13%) following TAE; mild ischemia without sequelae was observed in 3 patients and severe ischemias with bowel perforation requiring surgery in 2 patients. No variables were identified as significant predictive factors of failed TAE. CONCLUSION TAE is a safe and effective treatment to control massive acute LGIB, especially in the emergency setting with a clinical success rate of 63%.
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Affiliation(s)
- C Bua-Ngam
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - J Norasetsingh
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - T Treesit
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - B Wedsart
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - O Chansanti
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - J Tapaneeyakorn
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - T Panpikoon
- Vascular and body interventional radiology unit, department of diagnostic and therapeutic radiology, faculty of medicine, Ramathibodi hospital, Mahidol university, 270, Rama VI Road, 10400 Ratchathewi, Bangkok, Thailand.
| | - S A-O Vallibhakara
- Section of clinical epidemiology and biostatistics, faculty of medicine, Ramathibodi hospital, Mahidol university, Bangkok, Thailand.
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Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding. Langenbecks Arch Surg 2017; 402:509-519. [DOI: 10.1007/s00423-017-1552-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/04/2017] [Indexed: 02/06/2023]
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Soto JA, Park SH, Fletcher JG, Fidler JL. Gastrointestinal hemorrhage: evaluation with MDCT. ACTA ACUST UNITED AC 2016; 40:993-1009. [PMID: 25637128 DOI: 10.1007/s00261-015-0365-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastrointestinal (GI) bleeding is a common medical problem, with high associated morbidity and mortality. The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage. However, implementation of upper tract endoscopy and colonoscopy in the emergency setting can be challenging due to inconsistent availability of the service and difficulties in achieving adequate colonic cleansing in emergent situations. Thus, imaging tests are often relied upon to establish the location and the cause of bleeding, either for initial diagnosis or after non-revealing upper and lower tract endoscopies ("obscure" bleeding). This article discusses the imaging evaluation of patients with gastrointestinal bleeding and reviews the imaging appearance of the most common causes, taking into account the two most relevant clinical presentations: overt bleeding and obscure bleeding.
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Affiliation(s)
- Jorge A Soto
- Boston University and Boston Medical Center, 820 Harrison Avenue, FGH3, Boston, MA, 02118, USA,
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Bagdasarov VV, Bagdasarova EA, Chernookov AI, Ataian AA, Karchevskiĭ EV, V D. [Endovascular arterial embolization for duodenal bleeding as an alternative to surgical approach]. Khirurgiia (Mosk) 2016:45-50. [PMID: 26977867 DOI: 10.17116/hirurgia2016245-50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To present possibilities of transcatheter arterial embolization (TAE) in duodenal bleeding management. MATERIAL AND METHODS Treatment of 212 patients with acute duodenal bleeding for the period from 2012 to 2014 was analyzed. In 32 (22.5%) patients of the study group bleeding recurrence or its high risk was indication for TAE. RESULTS Change of surgical tactics for bleeding from upper gastrointestinal tract including endoscopic hemostasis optimization, wide introduction of TAE and sharp decrease of surgical activity reduced overall mortality to 1.6% in 2012--2014. CONCLUSION TAE is effective to control bleeding and reduces mortality rate especially in high risk and elderly patients.
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Affiliation(s)
- V V Bagdasarov
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
| | - E A Bagdasarova
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
| | - A I Chernookov
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
| | - A A Ataian
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
| | - E V Karchevskiĭ
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
| | - D V
- I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian Federation
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Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther 2015; 6:172-182. [PMID: 26558151 PMCID: PMC4635157 DOI: 10.4292/wjgpt.v6.i4.172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/06/2015] [Accepted: 10/09/2015] [Indexed: 02/06/2023] Open
Abstract
Non-variceal upper gastrointestinal bleeding (UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions, erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor (PPI) therapy. These drugs are highly effective but the best route of application (oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal anti-inflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.
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Tanveer-Ul-Haq, Idris M, Salam B, Akhtar W, Jamil Y. Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage. Pak J Med Sci 2015; 31:751-6. [PMID: 26430397 PMCID: PMC4590394 DOI: 10.12669/pjms.314.7240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage. Methods: This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (χ2) square and Fisher’s exact tests were applied and a P-value of less than 0.05 was considered statistically significant. Results: Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% (36/57) and 35% (20/57) cases respectively. Technical success was achieved in all cases (100%). Clinical success rate was higher in microcoils group (92%) than PVA particles group (75%) with statistically significant P value (p=0.048). Ischemic complication was seen in one case (3%) in the microcoil group, while no such complications were seen in the PVA particles group. Conclusion: In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates.
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Affiliation(s)
- Tanveer-Ul-Haq
- Dr. Tanveer-Ul-Haq, FRCR, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Muhammad Idris
- Dr. Muhammad Idris, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Basit Salam
- Dr. Basit Salam, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Waseem Akhtar
- Dr. Waseem Akhtar, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Yasir Jamil
- Dr. Yasir Jamil, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
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Clinical outcome of transcatheter arterial embolization with N-butyl-2-cyanoacrylate for control of acute gastrointestinal tract bleeding. AJR Am J Roentgenol 2015; 204:662-8. [PMID: 25714300 DOI: 10.2214/ajr.14.12683] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of trans-catheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes. MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests. RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancer-related bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% (78/102), respectively. Procedure-related complications included bowel infarction, which was noted in two patients. Recurrent bleeding and bleeding-related 30-day mortality rates were 15.7% (16/102) and 8.8% (9/102), respectively. Cancer-related bleeding increased clinical failure significantly (p = 0.003) and bleeding-related 30-day mortality with marginal significance (p = 0.05). Overall survival was poorer in patients with cancer-related bleeding. CONCLUSION. TAE with NBCA with or without other embolic agents showed high technical and clinical effectiveness in the management of acute nonvariceal gastrointestinal tract bleeding. Cancer-related bleeding was the only factor related to clinical failure, and possibly related to bleeding-related 30-day mortality.
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Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am 2014; 43:739-52. [PMID: 25440922 DOI: 10.1016/j.gtc.2014.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding.
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Affiliation(s)
- Sujal M Nanavati
- Interventional Radiology, Department of Radiology and Biomedical Imaging, UCSF, 1001 Potrero Avenue, Rm. 1x55, San Francisco, CA 94110, USA.
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Particle Embolization: Factors Affecting Arterial Distribution. J Vasc Interv Radiol 2014; 25:1773-4. [DOI: 10.1016/j.jvir.2014.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 11/21/2022] Open
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Outcomes of patients with acute upper gastrointestinal nonvariceal hemorrhage referred to interventional radiology for potential embolotherapy. J Clin Gastroenterol 2014; 48:687-92. [PMID: 25014238 DOI: 10.1097/mcg.0000000000000181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To report the outcomes following catheter angiography with or without embolization in patients with acute upper gastrointestinal nonvariceal hemorrhage (UGINH). MATERIALS AND METHODS A review of electronic medical records was performed to identify all potential patients for this study between 2001 and 2011. Patients with first-time UGINH who required angiographic localization and endovascular treatment were included. Patients with variceal bleeding and prior surgical or endovascular intervention for the gastrointestinal system were excluded. Society of Interventional Radiology guidelines and American College of Radiology "appropriateness criteria" reporting standards were followed. RESULTS We identified 74 patients (men/women=46/28) with a mean age of 60 years. Thirty-four patients were found to have active bleeding on angiography. One patient from this group did not undergo embolization because of an angiographic diagnosis of aortoenteric fistula. Technical failure was encountered in 2/34 patients; therefore, the technical success of embolization was 94%. Forty of 74 patients showed no angiographic evidence of active bleeding; 18 patients underwent prophylactic embolization using endoscopically placed clips as targets; and 22 patients had no embolotherapy. Thus, we grouped the patients into 3 groups: (1) therapeutic embolization; (2) prophylactic/empiric embolization; and (3) no embolotherapy groups. The clinical success of embolization was 67% to 68% in the therapeutic embolization group and 67% in the prophylactic embolization group. Early rebleeding rates were 33.8%, 51.6%, 33.3%, and 12% among all the patients, the therapeutic embolization group, the prophylactic embolization group, and the no endovascular treatment group, respectively. Mortality was significantly high in patients with advanced age (P=0.001), cerebrovascular disorders (P=0.037), and positive angiography (P=0.026), even when clinical success was achieved. CONCLUSIONS Acute UGINH remains a clinical challenge with increased mortality rates, even with high technical success rates. Patients with negative findings on angiography have lower early rebleeding rates than patients with active bleeding during angiography or endoscopy-guided prophylactic/empiric embolization.
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Maleux G, Bielen J, Laenen A, Heye S, Vaninbroukx J, Laleman W, Verhamme P, Wilmer A, Van Steenbergen W. Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome. Eur Radiol 2014; 24:2779-86. [PMID: 25063394 DOI: 10.1007/s00330-014-3332-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality. MATERIALS AND METHODS From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected. RESULTS Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012). CONCLUSION Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival. KEY POINTS • Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding • The rate of rebleeding is acceptably low • Haemostatic disorders appear to significantly influence 30-day survival.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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Liang HL, Chiang CL, Chen MCY, Lin YH, Huang JS, Pan HB. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report. Eur J Radiol 2014; 83:1811-5. [PMID: 25043985 DOI: 10.1016/j.ejrad.2014.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/04/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3-5 units/h) for 3h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. RESULTS Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. CONCLUSIONS Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.
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Affiliation(s)
- Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan.
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
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Loffroy R. Prophylactic arterial embolization in high-risk peptic ulcer bleeding after endoscopic hemostasis is achieved: a new step. Scand J Gastroenterol 2014; 49:772-3. [PMID: 24730373 DOI: 10.3109/00365521.2014.898785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Romaric Loffroy
- Department of Vascular, Oncologic and Interventional Radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital , 14 Rue Paul Gaffarel, BP77908, 21079 Dijon Cedex , France
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Ramaswamy RS, Choi HW, Mouser HC, Narsinh KH, McCammack KC, Treesit T, Kinney TB. Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol 2014; 6:82-92. [PMID: 24778770 PMCID: PMC4000612 DOI: 10.4329/wjr.v6.i4.82] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/20/2014] [Accepted: 03/11/2014] [Indexed: 02/06/2023] Open
Abstract
Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB.
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Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol 2014; 25:839-46. [PMID: 24755085 DOI: 10.1016/j.jvir.2014.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/16/2014] [Accepted: 02/17/2014] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, California) as the primary treatment for acute and massive lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS Between January 2008 and October 2013, all patients with focal massive LGIB who were treated by embolization were retrospectively analyzed. The study was approved by the hospital's ethics committee; informed consent was obtained in all cases. Onyx was chosen as the embolic agent in all cases in an intention-to-treat fashion. Embolization was indicated in 31 consecutive patients (mean age, 80 y ± 11.1). Multidetector computed tomography and digital subtraction angiography were performed in all patients. RESULTS Active bleeding was detected in all cases. A colonoscopy was performed in 11 patients. The correlation between multidetector computed tomography and angiography findings was 96.7%. The causes of bleeding were diverticula in 15 patients, iatrogenic in 7 patients, neoplasia in 3 patients, hemorrhoids in 2 patients, angiodysplasia in 2 patients, and unknown in 2 patients. Embolization was not possible in one patient, who required urgent left hemicolectomy. The technical success rate was 93.5%. The embolic material refluxed in one patient, causing an undesired embolization, without any clinical consequences. In the 30 patients who received embolization, the immediate bleeding control rate was 100%. Rebleeding at 30 days occurred in three patients (10%). There were no major complications, intestinal ischemia, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 23.7 months (range, 1-71 mo). CONCLUSIONS Control of massive LGIB using superselective embolization with Onyx is feasible and safe.
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Relevance of Surgery after Embolization of Gastrointestinal and Abdominal Hemorrhage. World J Surg 2014; 38:2258-66. [DOI: 10.1007/s00268-014-2570-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hongsakul K, Pakdeejit S, Tanutit P. Outcome and predictive factors of successful transarterial embolization for the treatment of acute gastrointestinal hemorrhage. Acta Radiol 2014; 55:186-94. [PMID: 23904090 DOI: 10.1177/0284185113494985] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transarterial embolization (TAE) is an effective procedure for the treatment of acute gastrointestinal bleeding (GIB). Factors associated with clinical success have not been well delineated. PURPOSE To evaluate the technical and clinical successes of TAE for acute GIB in order to identify factors influencing clinical success and in-hospital mortality. MATERIAL AND METHODS This was a retrospective study of 70 consecutive patients with GIB who underwent angiography and embolization between January 2004 and December 2011. The technical success rate, clinical success rate, and in-hospital mortality were calculated by percentage. Clinical parameters, angiographic, and embolization data were assessed for factors influencing clinical success and in-hospital survival using univariate and multivariate analysis. Statistical significance was set at P value <0.05. RESULTS The technical success rate was 98.6%. The primary clinical success rate was 71.4% and the secondary clinical success rate after repeat embolization was 78.6%. Bowel infarction was the most serious complication of three (4.3%) patients. Failure to achieve 30-day hemostasis can be predicted in patients who have one or more of the following factors: hemoglobin concentration <8 g/dL (P = 0.004), coagulopathy (P = 0.005), upper GIB (P = 0.02), contrast extravasation (P = 0.012), and more than one embolized vessel (P = 0.005). In-hospital survival is affected by the amount of transfused packed red blood cells before embolization (P = 0.008) and post-embolization bowel infarction (P = 0.005). CONCLUSION TAE is a feasible and effective management of acute GIB with high technical and clinical success rates. The factors influencing clinical success include hemoglobin concentration, coagulopathy, upper GIB, contrast extravasation, and more than one embolized vessel. The number of units of transfused packed red blood cells and post-embolization bowel infarction are important factors associated with in-hospital mortality.
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Affiliation(s)
- Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Songklod Pakdeejit
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pramot Tanutit
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. J Trauma Acute Care Surg 2013; 75:398-403. [PMID: 23928742 DOI: 10.1097/ta.0b013e31829a8b7a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Therapeutic angioembolization is a relatively new "rescue treatment" modality for gastrointestinal hemorrhage (GIH) for unstable patients who fail primary treatment approaches; however, the effectiveness of this treatment and the incidence of ischemic necrosis following embolization for acute GIH are poorly described. The purpose of this study was to evaluate the effectiveness and safety of "rescue" transcatheter superselective angioembolization (SSAE) for the treatment of hemodynamically unstable patients with GIH. METHODS A 10-year retrospective review of all hemodynamically unstable patients (systolic blood pressure < 90 mm Hg and ongoing transfusion requirement) who underwent "rescue" SSAE for GIH after failed endoscopic management was performed. All patients with evidence of active contrast extravasation were included. Data were collected on demographics, comorbidities, clinical presentation, and type of intravascular angioembolic agent used. Outcomes included technical success (cessation of extravasation), clinical success (no rebleeding requiring intervention within 30 days), and incidence of ischemic complications. RESULTS Ninety-eight patients underwent SSAE for GIH during the study period; 47 were excluded owing to lack of active contrast extravasation. Of the remaining 51 patients, 22 (43%) presented with a lower GIH and 29 (57%) with upper GIH. The majority underwent embolization with a permanent agent (71%), while the remaining patients received either a temporary agent (16%) or a combination (14%). The overall technical and clinical success rates were 98% and 71%, respectively. Of the 14 patients with technical success but clinical failure (rebleeding within 30 days) and the 1 patient with technical failure, 4 were managed successfully with reembolization, while 2 underwent successful endoscopic therapy, and 9 had surgical resections. Only one patient had an ischemic complication (small bowel necrosis) requiring resection. CONCLUSION SSAE, with reembolization if necessary, is an effective rescue treatment modality for hemodynamically unstable patients with active GIH. Of the patients, 20% will fail SSAE and require additional intervention. Ischemic complications are extremely rare. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Dunne R, McCarthy E, Joyce E, McEniff N, Guiney M, Ryan JM, Beddy P. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach. Acta Radiol 2013; 54:1159-64. [PMID: 23892235 DOI: 10.1177/0284185113491567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations. PURPOSE To evaluate the technical and clinical success of transcatheter arterial embolization via micro coils in the management of bleeding post-endoscopic sphincterotomy (ES). MATERIAL AND METHODS An 8-year retrospective review of all patients referred for transcatheter arterial embolization (TAE) for management of post-ES bleeding not controlled by endoscopy was performed. We analyzed the findings at endoscopy, angiography, interventional procedure, and the technical and clinical success. RESULTS Twelve embolization procedures were performed in 11 patients. Technical success was achieved in 11 of 12 procedures. Branches embolized included the gastroduodenal artery (GDA) in 11 cases, the superior pancreaticoduodenal artery (SPDA) in one case, and the inferior pancreaticoduodenal artery (IPDA) in four cases. Clinical success was achieved in 10 of 11 patients. One patient was referred for surgical intervention due to rebleeding from the IPDA. CONCLUSION Our experience demonstrates that TAE can effectively control bleeding post-ES avoiding the need for invasive surgery in most patients.
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Affiliation(s)
- Ruth Dunne
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Eoghan McCarthy
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Eimear Joyce
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Niall McEniff
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Michael Guiney
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - J Mark Ryan
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Peter Beddy
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
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Han MS, Park BK, Lee SH, Yang HC, Hong YK, Choi YJ. [A case of Dieulafoy lesion of the jejunum presented with massive hemorrhage]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 61:279-81. [PMID: 23756670 DOI: 10.4166/kjg.2013.61.5.279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. Although it may occur anywhere in the gastrointestinal tract, the lesion is most commonly located in the stomach, and the small bowel is an extremely uncommon site. Since Dieulafoy lesion in the small bowel is difficult to access by endoscopy, it seems impossible to diagnose and treat by initial endoscopy unlike the lesions in stomach. We experienced a case of Dieulafoy lesion of jejunum with massive hemorrhage in 54-year-old male. Active jejunal bleeding was shown by computed tomography scan and mesenteric angiography. Partial resection of the jejunum was performed. Final pathologic finding revealed Dieulafoy lesion of the jejunum.
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Affiliation(s)
- Min Seok Han
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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