03:18 PM Abstract No. 337 Transcatheter embolization for upper GI bleed: outcomes of empiric vs. selective embolization

Abstract

To compare clinical outcomes between empiric embolization for angiographically occult upper GI bleed with selective embolization for angiographically detectable upper GI bleed. This IRB-exempt retrospective study reviewed 47 patients who underwent gastroduodenal artery (GDA) and left gastric artery (LGA) embolization for acute upper GI bleed at our institution between June 2009 to April 2017. 22 patients underwent prophylactic embolization while 25 patients underwent selective embolization. Demographics, smoking history, alcohol use, ICU needs, 30-day mortality rates, endoscopic interventions, major IR complication rates, rebleed rates and transfusion requirements were compared between groups using student T test and Chi-square test. There were significant gender differences between the empiric embolization group (14% females) and the selective embolization group (48% females, p=.014). There was no significant difference in age distribution, smoking history, or past and current alcohol use between the two groups. There were no differences in major IR complication rates after embolization. In the empiric embolization group, ICU needs (86% vs. 44%, p=.003) were greater. The empiric embolization group had greater rebleeding rate (41% vs. 12%, p=.024) and had higher proportion of cases requiring greater than 5 units of PRBC after embolization (32% vs. 0%, p=.002). However, there were no significant differences in need for endoscopic intervention post embolization (14% vs. 8%, p=.5). There were no significant differences in 30 day mortality rates (22.7% vs. 20%, p=.82). Selective embolization is more clinically effective for cessation of upper GI bleeding when compared to empiric embolization of the GDA and LGA with less rebleeding rates and transfusion requirements. However, the difference in 30 day mortality rates and the need for endoscopic intervention post embolization between the two groups are insignificant.