Transcatheter Arterial Embolization of Acute Upper Gastrointestinal Tract Bleeding with N-Butyl-2-Cyanoacrylate

Abstract

PURPOSEl: To retrospectively analyze outcomes in patients who received an iodized oil formulation of N-butyl-2-cyanoacrylate to treat acute nonvariceal upper gastrointestinal tract bleeding. Sixteen patients with acute upper gastrointestinal tract bleeding underwent angiography and transarterial embolization between April 2004 and December 2005. Patients with negative findings at arteriography and those with lesions in large vessels that did not necessitate a microcatheter for catheterization were excluded. Three types of embolization were used according to the accessible arteries: Localized embolization was used in the bleeding artery, and distal (segmental) or proximal embolization was used in the parent artery according to the final position of the catheter tip. Outcomes, including hemostasis, recurrent bleeding, and complications, were recorded. Immediate hemostasis was achieved in 14 patients (88%). One (6%) patient had technical failure due to arterial dissection, and one (6%) patient had therapeutic failure due to multiple ulcers and coagulopathy. Of the 14 patients with immediate hemostasis, one (7%) had recurrent bleeding 5 days after embolization. Both patients in whom hemostasis was not achieved (12%) died within 1 month of follow-up. Multiple gastric ulcers were seen in two (12%) patients who underwent embolization of a large area, and conservative treatment was sufficient. The results of this preliminary experience indicate that transarterial embolization with the iodized oil formulation is feasible and effective in the management of nonvariceal upper gastrointestinal tract bleeding; however, a larger number of cases should be investigated.