Glue embolization for endoscopically unmanageable gastrointestinal haemorrhage

Area of Science:

• Interventional Radiology
• Gastroenterology
• Vascular Surgery

Background:

• Endoscopic management is often insufficient for severe non-variceal gastrointestinal hemorrhage (GIH).
• Emergency embolization is a critical intervention for hemorrhage control in hemodynamically unstable patients.
• N-butyl cyanoacrylate (NBCA) is an embolic agent with potential applications in GIH management.

Purpose of the Study:

• To assess the clinical feasibility and effectiveness of NBCA embolization for endoscopically unmanageable GIH.
• To evaluate the technical and clinical success rates of NBCA embolization in patients with severe GIH.
• To identify factors influencing the outcomes of NBCA embolization for GIH.

Main Methods:

• Retrospective analysis of 61 patients with acute GIH undergoing emergency embolization.
• NBCA embolization was specifically used in 28 patients in shock despite transfusions.
• Assessment of technical success, clinical success, and mortality based on clinical and embolization data.

Main Results:

• Technical success was achieved in all 28 patients treated with NBCA.
• Clinical success was observed in 68% (19/28) of patients.
• Mortality rate was 25% (7/28), with coagulopathy/DIC significantly decreasing clinical success and increasing mortality.

Conclusions:

• NBCA embolization is technically feasible and effective for controlling endoscopically unmanageable GIH.
• Coagulopathy and disseminated intravascular coagulation (DIC) are critical factors negatively impacting clinical success and survival.
• Careful patient selection and management of coagulopathy are crucial for optimizing NBCA embolization outcomes in GIH.