Efficacy and safety of superselective trans-catheter arterial embolization of upper and lower gastrointestinal bleeding using N-butyl-2-cyanoacrylate.

Abstract

To evaluate the efficacy and safety of superselective trans-catheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) for patients with acute non-variceal upper and lower gastrointestinal (GI) bleeding. TAE using NBCA was performed in 21 patients (13 males, 8 females, mean age 60.9years) with acute non-variceal upper (n=15) and lower (n=6) GI bleeding. TAE using other embolic agents was performed in 25 patients (13 males, 12 females, mean age 69.1years) with acute non-variceal upper (n=16) and lower (n=9) GI bleeding. Technical success, clinical success, clinical failure, major and minor complications, bleeding-related 30-day mortality, and overall in-hospital mortality were analyzed. In 21 patients who underwent TAE with NBCA, the overall technical success was 100% (21/21) and overall clinical success was 72.2% (13/18). Uncontrolled bleeding, recurrent bleeding, and clinical failure were seen in 11.1% (2/18), 16.7% (3/18), and 27.8% (5/18) of cases, respectively. The minor complication rate was 16.7% (4/21) and no major complications occurred. Three patients showed ischemic damage in the treated lesion and one patient showed epigastric pain. The bleeding-related 30-day mortality and overall in-hospital mortality rates were 16.7% (3/18) and 28.6% (6/21), respectively. Two patients died of septic shock and one died of myocardial infarction within 30days after TAE. In 25 patients who underwent TAE with other agents, the overall technical success was 100% (25/25), and the overall clinical success was 68.2% (15/22). The rates of uncontrolled bleeding, recurrent bleeding, clinical failure, bleeding-related 30-day mortality, and overall in-hospital mortality were 0.5% (1/22), 22.7% (5/22), 31.8% (7/22), 22.7% (5/22), and 32.0% (8/25), respectively. TAE with NBCA for acute non-variceal upper and lower GI bleeding proved to be a technically feasible, safe, and effective treatment modality. Thus, NBCA could be used as a primary embolic agent for controlling GI bleeding.