The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding.

Abstract

IntroductionIn this study, we aim to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolisation in managing lower gastrointestinal bleeding (LGIB) at a multi-centre health service in Melbourne (Australia).MethodA retrospective case series of patients with LGIB treated with superselective embolisation in our area health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multi-detector CT angiography (CE-MDCT), were referred for DSA, and subsequently endovascular intervention. Data collected included patient characteristics; screening modality; bleeding territory; embolisation technique; technical and clinical success; short to mediumterm complications and mortality up to 30 days; and the need for surgery related to procedural failure or complications.ResultsThere were 55 hospital admissions with acute unstable lower gastrointestinal bleeding that were demonstrable on CE-MDCT or RS over a 30-month period (from 1 January 2014 to 30 June 2016). Of these, eighteen patients were embolised. Immediate haemostasis was achieved in all embolised cases. Eight patients (44%) had clinical re-bleeding postembolisation and warranted repeated imaging. However, only one case (5.6%) had active bleeding identified and was re-embolised. There was no documented case of bowel ischemia or ischemic-stricture and none progressed on to surgery. 30 day mortality was zero.ConclusionSuper-selective mesenteric embolisation is a viable, safe and effective first line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted first-line practice at our institution to manage localised LGIB with embolisation.