Transcatheter embolotherapy for gastrointestinal bleeding: A single center review of safety, efficacy, and clinical outcomes

Felix Y. Yap, Benedictta O. Omene, Milan N. Patel, Thomas Yohannan, Jeet Minocha, Grace Knuttinen, Charles A. Owens, James T. Bui, Ron C. Gaba

Research output: Contribution to journalArticle

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Abstract

Purpose: The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding. Materials and Methods: Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 %) patients had upper GI bleeds and 19/95 (20 %) patients had lower GI bleeds. A mean of 7 (range 0-27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 %) procedures were urgent or emergent. Twenty-seven of 95 (28 %) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates. Results: Bleeding etiology included peptic ulcer disease (45/95, 47 %), cancer (14/95, 15 %), diverticulosis (13/95, 14 %), and other (23/95, 24 %). Vessels embolized (n = 109) included gastroduodenal (42/109, 39 %), pancreaticoduodenal (22/109, 20 %), gastric (21/109, 19 %), superior mesenteric (12/109, 11 %), inferior mesenteric (8/109, 7 %), and splenic (4/109, 4 %) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 %) cases. Most common embolic agents included coils (66/109, 61 %) and/or gelatin sponge (19/109, 17 %). Targeted versus empiric embolization were performed in 57/95 (60 %) and 38/95 (40 %) cases, respectively. Complications included bowel ischemia (4/95, 4 %) and coil migration in 3/95 (3 %). 30-day rebleeding rate was 23 % (22/95). Overall 30-day mortality rate was 18 % (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 %) but higher mortality (31 vs 9 %) rates compared to embolization for active extravasation. Conclusions: TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.

Original languageEnglish (US)
Pages (from-to)1976-1984
Number of pages9
JournalDigestive Diseases and Sciences
Volume58
Issue number7
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

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Therapeutic Embolization
Hemorrhage
Safety
Mortality
Gastrointestinal Hemorrhage
Diverticulum
Porifera
Gelatin
Hemostasis
Peptic Ulcer
Stomach
Ischemia
Arteries
Erythrocytes
Neoplasms

Keywords

  • Efficacy
  • Gastrointestinal bleeding
  • Safety
  • Transcatheter embolotherapy

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Transcatheter embolotherapy for gastrointestinal bleeding : A single center review of safety, efficacy, and clinical outcomes. / Yap, Felix Y.; Omene, Benedictta O.; Patel, Milan N.; Yohannan, Thomas; Minocha, Jeet; Knuttinen, Grace; Owens, Charles A.; Bui, James T.; Gaba, Ron C.

In: Digestive Diseases and Sciences, Vol. 58, No. 7, 01.07.2013, p. 1976-1984.

Research output: Contribution to journalArticle

Yap, Felix Y. ; Omene, Benedictta O. ; Patel, Milan N. ; Yohannan, Thomas ; Minocha, Jeet ; Knuttinen, Grace ; Owens, Charles A. ; Bui, James T. ; Gaba, Ron C. / Transcatheter embolotherapy for gastrointestinal bleeding : A single center review of safety, efficacy, and clinical outcomes. In: Digestive Diseases and Sciences. 2013 ; Vol. 58, No. 7. pp. 1976-1984.
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abstract = "Purpose: The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding. Materials and Methods: Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 {\%}) patients had upper GI bleeds and 19/95 (20 {\%}) patients had lower GI bleeds. A mean of 7 (range 0-27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 {\%}) procedures were urgent or emergent. Twenty-seven of 95 (28 {\%}) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates. Results: Bleeding etiology included peptic ulcer disease (45/95, 47 {\%}), cancer (14/95, 15 {\%}), diverticulosis (13/95, 14 {\%}), and other (23/95, 24 {\%}). Vessels embolized (n = 109) included gastroduodenal (42/109, 39 {\%}), pancreaticoduodenal (22/109, 20 {\%}), gastric (21/109, 19 {\%}), superior mesenteric (12/109, 11 {\%}), inferior mesenteric (8/109, 7 {\%}), and splenic (4/109, 4 {\%}) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 {\%}) cases. Most common embolic agents included coils (66/109, 61 {\%}) and/or gelatin sponge (19/109, 17 {\%}). Targeted versus empiric embolization were performed in 57/95 (60 {\%}) and 38/95 (40 {\%}) cases, respectively. Complications included bowel ischemia (4/95, 4 {\%}) and coil migration in 3/95 (3 {\%}). 30-day rebleeding rate was 23 {\%} (22/95). Overall 30-day mortality rate was 18 {\%} (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 {\%}) but higher mortality (31 vs 9 {\%}) rates compared to embolization for active extravasation. Conclusions: TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.",
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T2 - A single center review of safety, efficacy, and clinical outcomes

AU - Yap, Felix Y.

AU - Omene, Benedictta O.

AU - Patel, Milan N.

AU - Yohannan, Thomas

AU - Minocha, Jeet

AU - Knuttinen, Grace

AU - Owens, Charles A.

AU - Bui, James T.

AU - Gaba, Ron C.

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N2 - Purpose: The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding. Materials and Methods: Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 %) patients had upper GI bleeds and 19/95 (20 %) patients had lower GI bleeds. A mean of 7 (range 0-27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 %) procedures were urgent or emergent. Twenty-seven of 95 (28 %) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates. Results: Bleeding etiology included peptic ulcer disease (45/95, 47 %), cancer (14/95, 15 %), diverticulosis (13/95, 14 %), and other (23/95, 24 %). Vessels embolized (n = 109) included gastroduodenal (42/109, 39 %), pancreaticoduodenal (22/109, 20 %), gastric (21/109, 19 %), superior mesenteric (12/109, 11 %), inferior mesenteric (8/109, 7 %), and splenic (4/109, 4 %) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 %) cases. Most common embolic agents included coils (66/109, 61 %) and/or gelatin sponge (19/109, 17 %). Targeted versus empiric embolization were performed in 57/95 (60 %) and 38/95 (40 %) cases, respectively. Complications included bowel ischemia (4/95, 4 %) and coil migration in 3/95 (3 %). 30-day rebleeding rate was 23 % (22/95). Overall 30-day mortality rate was 18 % (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 %) but higher mortality (31 vs 9 %) rates compared to embolization for active extravasation. Conclusions: TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.

AB - Purpose: The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding. Materials and Methods: Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 %) patients had upper GI bleeds and 19/95 (20 %) patients had lower GI bleeds. A mean of 7 (range 0-27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 %) procedures were urgent or emergent. Twenty-seven of 95 (28 %) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates. Results: Bleeding etiology included peptic ulcer disease (45/95, 47 %), cancer (14/95, 15 %), diverticulosis (13/95, 14 %), and other (23/95, 24 %). Vessels embolized (n = 109) included gastroduodenal (42/109, 39 %), pancreaticoduodenal (22/109, 20 %), gastric (21/109, 19 %), superior mesenteric (12/109, 11 %), inferior mesenteric (8/109, 7 %), and splenic (4/109, 4 %) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 %) cases. Most common embolic agents included coils (66/109, 61 %) and/or gelatin sponge (19/109, 17 %). Targeted versus empiric embolization were performed in 57/95 (60 %) and 38/95 (40 %) cases, respectively. Complications included bowel ischemia (4/95, 4 %) and coil migration in 3/95 (3 %). 30-day rebleeding rate was 23 % (22/95). Overall 30-day mortality rate was 18 % (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 %) but higher mortality (31 vs 9 %) rates compared to embolization for active extravasation. Conclusions: TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.

KW - Efficacy

KW - Gastrointestinal bleeding

KW - Safety

KW - Transcatheter embolotherapy

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