4:21 PM Abstract No. 110 ■ FEATURED ABSTRACT Safety and efficacy of transcatheter arterial embolization for upper gastrointestinal bleeding at a tertiary care center: a contemporary review

Abstract

To evaluate the safety and efficacy of transcatheter arterial embolization in the management of nonvariceal upper gastrointestinal bleeding (UGIB). All patients who underwent transcatheter arterial embolization intervention for UGIB at a single institution from September 2011 to October 2016 were included in this retrospective study. The rates of technical and clinical success, ischemic complications, in-hospital mortality, and recurrent bleeding were determined. Technical success was defined as the absence of angiographic signs of hemorrhage at the conclusion of the procedure. Clinical success was defined as technical success without major complication or recurrent bleeding within 30 days of embolization. Additionally, the etiology of bleeding, outcomes of preprocedure endoscopic intervention, imaging concordance, and embolic material used were evaluated. 109 UGIB transcatheter arterial embolization procedures were performed on 101 patients over this time period. 61 embolizations (56%) were performed for positive angiographic findings, and 48 embolizations (44%) were performed empirically. The most commonly identified etiologies included duodenal ulcer (22%), gastric cancer (14.7%), pancreatic cancer (6.4%), and Dieulafoy lesions (7.3%). 79 cases underwent endoscopy prior to embolization. A CT angiogram was performed in 13 cases and was concordant with the angiogram performed during embolization 84.6% of the time. A nuclear medicine study was performed in 6 cases and was concordant with the angiogram performed during embolization 83.3% of the time. Embolic material used included coils only (56.9%), Gelfoam only (7.3%), particles only (6.4%), liquid embolic only (5.6%), or a combination of the above (23.9%). For all cases evaluated, the clinical success, ischemic complications, recurrent bleeding, and in-hospital mortality were 67%, 0%, 33%, and 33.7%, respectively. Modern equipment and techniques for transcatheter arterial embolization have maximized technical success rates and minimized ischemic complications, but clinical success rates remain similar to historical controls.