Abstract
BackgroundAngiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation.MethodsThe clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed.ResultsOf the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154–0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012).ConclusionsAngiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients.
Highlights
Angiographic embolization is considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy
Baseline characteristics according to the angiographic visualization of extravasation Of the 138 patients, 58 (42.0%) were with angiographic visualization of extravasation with mean time-to-angiography of 7.3 h
The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), and short time-to-angiography (p = 0.031)
Summary
Angiographic embolization is considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. To date, no controlled trial has compared angiographic embolization to surgery as a salvage procedure for patients with acute GI bleeding refractory to endoscopic therapy. Angiographic embolization controls acute GI bleeding in a high proportion of patients including the critically ill and those who had previously undergone surgery [9, 10]. This technique is considered the first-line therapy for massive GI bleeding that is refractory to endoscopic therapy
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