Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center.

Azeemuddin Muhammad,Raza Sayani,Saqib Qamar,Noor U Baloch,Muhammad Awais,Muhammad Anwar Saeed,Abdul Rehman

doi:10.7759/cureus.4228

Abstract

PurposeIn 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.MethodsAll 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.ResultsA 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.ConclusionEmpiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.

Highlights

Gastrointestinal bleeding (GIB) accounts for more than 500,000 hospital admissions annually in the United States with a cumulative healthcare cost of nearly five billion dollars [1]
We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent gastrointestinal bleeding (GIB)
Transcatheter arterial embolization (TAE) is a commonly performed procedure and an estimated 1.7 million TAE procedures were performed in the United States in 2001 [8]

Summary

Introduction

Gastrointestinal bleeding (GIB) accounts for more than 500,000 hospital admissions annually in the United States with a cumulative healthcare cost of nearly five billion dollars [1]. Endoscopic therapy is considered the first-line treatment for patients with massive gastrointestinal hemorrhage [3,4]. This may not be possible in 8-25% of cases where endoscopic therapy may be unsuccessful [5], or may not be technically feasible [6]. When DSA fails to demonstrate any overt signs of bleeding, the decision to perform TAE of a specific vessel becomes complicated. In many such cases, if the anatomic site of bleeding is known, 'empiric' TAE of the

Methods

Results

Conclusion