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Transcatheter embolization effectively controls acute lower gastrointestinal bleeding without localizing bleeding
Han Hee Lee1,2, Jung Suk Oh3, Jae Myung Park1,2
1a Division of Gastroenterology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Korea.
Insights
Transcatheter arterial embolization (TAE) is effective for treating lower gastrointestinal bleeding (LGIB) when colonoscopy fails. This study shows TAE success even without precisely locating the bleeding site, offering a viable alternative to surgery.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Colonoscopy is the primary treatment for lower gastrointestinal bleeding (LGIB).
- Endoscopic failure due to factors like poor bowel preparation necessitates alternative treatments.
- Surgery or transcatheter arterial embolization (TAE) are options following endoscopic failure.
Purpose of the Study:
- To evaluate the efficacy and safety of TAE for LGIB in patients who experienced endoscopic failure.
- To compare outcomes of TAE with and without precise localization of the bleeding source.
Main Methods:
- Retrospective analysis of 52 patients with acute LGIB treated with TAE between January 2005 and June 2015.
- Assessment of technical success, complications, and 30-day rebleeding and mortality rates.
- Comparison of outcomes based on whether the bleeding site was localized before TAE.
Main Results:
- TAE achieved technical success in all patients.
- The 30-day rebleeding rate was 27% and the mortality rate was 29%.
- No significant differences in rebleeding or mortality were observed between patients with and without localized bleeding sites; however, bowel infarction occurred in two patients without localization.
Conclusions:
- Transcatheter arterial embolization (TAE) is an effective treatment for lower gastrointestinal bleeding (LGIB), even when the bleeding source cannot be precisely localized.
- TAE provides a valuable alternative to surgery for patients with endoscopic failure in managing LGIB.
Background And Aims:
Colonoscopy is preferred for treatment of lower gastrointestinal bleeding (LGIB). However, several conditions such as poor bowel preparation can cause endoscopic failure, leading to surgery or transcatheter therapy as alternative options. We aimed to assess the efficacy and safety of transcatheter arterial embolization (TAE) for LGIB in patients with endoscopic failure.
Methods:
Between January 2005 and June 2015, 93 consecutive patients with acute LGIB underwent visceral angiography at three academic hospitals. Among them, a total of 52 patients were treated with TAE for LGIB and analyzed. Technical success, complications and 30-day rebleeding and mortality after TAE were investigated retrospectively in patients with and without localization of LGIB.
Results:
Technical success of TAE was achieved in all patients. After TAE, 30-day rebleeding and mortality rate were 27% (14/52) and 29% (15/52), respectively. TAE was performed without localizing bleeding site in 32 of 52 patients (62%). Between patients with and without localized bleeding site, there were no significant differences in 30-day rebleeding rate (25% vs. 28%) and mortality rate (15% vs. 38%). Causes of death were mostly unrelated to bleeding. Only two cases of bowel infarction occurred after TAE in patients without bleeding site localization. Rebleeding could be predicted if the patient received more than six units of packed red blood cell transfusion before TAE in multivariate analysis.
Conclusions:
TAE can be an effective treatment for LGIB even without localizing bleeding site.
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