Abstract No. 263: Transcatheter arterial embolization for the management of gastrointestinal hemorrhage from a neoplastic source

Abstract

PurposeTo evaluate the safety and efficacy of transcatheter embolization for patients with GI bleeding arising directly from a malignancy involving the GI tract wall.Materials and MethodsBetween 2005 and 2010, 41 mesenteric angiograms were performed on 28 patients (22 men, 6 women; mean age 55 years) with bleeding from a primary or metastatic tumor involving the GI tract wall as demonstrated endoscopically or radiologically. Embolization was performed in 27 procedures using particles and/or coils. Tumors were classified as hypovascular (n=29) or hypervascular (n=12). The angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as resolution of signs and symptoms of hemorrhage in the 30 days following embolization.ResultsAngiographic findings most commonly included tumor staining and/or regional hypervascularity. Nine studies had no abnormal findings. Cessation of hemorrhage (clinical success) occurred in 63% of procedures where embolization was performed. In contrast, spontaneous cessation of hemorrhage occurred in only 21% of procedures where embolization was not performed (p = 0.02). Stratified by tumor vascularity, clinical success after embolization was similar in hypovascular tumors (68.4%) versus hypervascular tumors (50%),(p=0.41). Five patients with clinically successful embolization had recurrent hemorrhage at a mean of 113 days (range 37-282). The incidence of rebleeding was significantly higher among patients with hypervascular tumors (p=0.04). There were no significant differences in clinical success based on angiographic findings or embolization method. There was one major complication: GI ischemia leading to perforation following particle embolization of a carcinoid tumor in the ileum. No procedure-related deaths were encountered.ConclusionArterial embolization is safe and effective for the palliation of GI hemorrhage from a direct tumor source. Following embolization, hypervascular tumors are more likely to rebleed compared to hypovascular tumors. PurposeTo evaluate the safety and efficacy of transcatheter embolization for patients with GI bleeding arising directly from a malignancy involving the GI tract wall. To evaluate the safety and efficacy of transcatheter embolization for patients with GI bleeding arising directly from a malignancy involving the GI tract wall. Materials and MethodsBetween 2005 and 2010, 41 mesenteric angiograms were performed on 28 patients (22 men, 6 women; mean age 55 years) with bleeding from a primary or metastatic tumor involving the GI tract wall as demonstrated endoscopically or radiologically. Embolization was performed in 27 procedures using particles and/or coils. Tumors were classified as hypovascular (n=29) or hypervascular (n=12). The angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as resolution of signs and symptoms of hemorrhage in the 30 days following embolization. Between 2005 and 2010, 41 mesenteric angiograms were performed on 28 patients (22 men, 6 women; mean age 55 years) with bleeding from a primary or metastatic tumor involving the GI tract wall as demonstrated endoscopically or radiologically. Embolization was performed in 27 procedures using particles and/or coils. Tumors were classified as hypovascular (n=29) or hypervascular (n=12). The angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as resolution of signs and symptoms of hemorrhage in the 30 days following embolization. ResultsAngiographic findings most commonly included tumor staining and/or regional hypervascularity. Nine studies had no abnormal findings. Cessation of hemorrhage (clinical success) occurred in 63% of procedures where embolization was performed. In contrast, spontaneous cessation of hemorrhage occurred in only 21% of procedures where embolization was not performed (p = 0.02). Stratified by tumor vascularity, clinical success after embolization was similar in hypovascular tumors (68.4%) versus hypervascular tumors (50%),(p=0.41). Five patients with clinically successful embolization had recurrent hemorrhage at a mean of 113 days (range 37-282). The incidence of rebleeding was significantly higher among patients with hypervascular tumors (p=0.04). There were no significant differences in clinical success based on angiographic findings or embolization method. There was one major complication: GI ischemia leading to perforation following particle embolization of a carcinoid tumor in the ileum. No procedure-related deaths were encountered. Angiographic findings most commonly included tumor staining and/or regional hypervascularity. Nine studies had no abnormal findings. Cessation of hemorrhage (clinical success) occurred in 63% of procedures where embolization was performed. In contrast, spontaneous cessation of hemorrhage occurred in only 21% of procedures where embolization was not performed (p = 0.02). Stratified by tumor vascularity, clinical success after embolization was similar in hypovascular tumors (68.4%) versus hypervascular tumors (50%),(p=0.41). Five patients with clinically successful embolization had recurrent hemorrhage at a mean of 113 days (range 37-282). The incidence of rebleeding was significantly higher among patients with hypervascular tumors (p=0.04). There were no significant differences in clinical success based on angiographic findings or embolization method. There was one major complication: GI ischemia leading to perforation following particle embolization of a carcinoid tumor in the ileum. No procedure-related deaths were encountered. ConclusionArterial embolization is safe and effective for the palliation of GI hemorrhage from a direct tumor source. Following embolization, hypervascular tumors are more likely to rebleed compared to hypovascular tumors. Arterial embolization is safe and effective for the palliation of GI hemorrhage from a direct tumor source. Following embolization, hypervascular tumors are more likely to rebleed compared to hypovascular tumors.