Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding

Area of Science:

• Interventional Radiology
• Gastroenterology
• Medical Imaging

Background:

• Acute lower gastrointestinal bleeding (LGIB) poses significant clinical challenges, particularly when initial diagnostic angiography is negative.
• Conventional management for LGIB with negative digital subtraction angiography (DSA) often involves a conservative approach, leading to potential rebleeding.

Purpose of the Study:

• To evaluate the clinical efficacy and safety of cone-beam CT (CBCT)-guided empirical embolization for acute LGIB.
• To assess this technique in patients with positive CT angiography (CTA) but negative DSA findings.

Main Methods:

• Retrospective analysis of 85 LGIB patients with positive CTA and subsequent DSA (January 2008-July 2019).
• Comparison of outcomes between targeted embolization (positive DSA), empiric CBCT-guided embolization (negative DSA), and no embolization (negative DSA).
• Analysis included recurrent bleeding, ischemic complications, and mortality, with subgroup analysis for hemodynamic instability.

Main Results:

• Technical success for both targeted and empiric embolization was 100%.
• Recurrent bleeding rates were 17.0% (targeted), 21.1% (empiric), and 52.6% (no embolization).
• Empiric CBCT-guided embolization significantly reduced rebleeding in hemodynamically unstable patients (3/10 vs. 10/12, p=0.027) compared to no embolization.

Conclusions:

• Empiric CBCT-guided embolization is a feasible, safe, and effective strategy for managing acute LGIB in patients with positive CTA but negative DSA.
• This technique significantly reduces rebleeding rates and improves clinical success, particularly in hemodynamically unstable individuals.
• CBCT guidance extends the utility of empirical embolization, offering a proactive treatment option beyond conservative management.