Upper Gastrointestinal Hemorrhage and Transcatheter Embolotherapy: Clinical and Technical Factors Impacting Success and Survival
Section snippets
Patients
We conducted a retrospective review of all patients (n = 178) who underwent arterial embolization for acute nonvariceal upper GI hemorrhage at a university hospital between December 1988 and May 2000. Fifteen cases were excluded because of incomplete medical records. All the remaining patients (n = 163) had an episode of massive acute bleeding within 7 days of the procedure. Patients requiring at least four units of blood per 24 hours were classified as having massive hemorrhage. This cohort
Clinical and Angiographic Data
The cause of bleeding was determined endoscopically, surgically and, in one case, angiographically. One hundred forty-seven of 163 patients (90%) had endoscopy immediately before or within 12 hours of angiography. The remaining patients were referred for angiography after bleeding was demonstrated by exploratory laparotomy (8), computed tomography (3), or hemobilia from a percutaneous drain (3) or duodenostomy (1). Findings at follow-up endoscopy were used whenever possible to confirm diagnoses.
DISCUSSION
The vast majority of patients with acute upper GI hemorrhage respond to conservative measures or endoscopic intervention (15). However, conservative therapy failed in all our patients and they faced surgery or imminent death from continued massive upper GI hemorrhage. A large body of literature supports the use of transcatheter embolotherapy in patients with upper GI hemorrhage (16, 17, 18, 19, 20, 21, 22, 23, 24). In 1986, Gomes et al (9) established the superiority of embolotherapy over
Acknowledgments
The authors thank Evelyn Stainthorpe, our Clinical Research Coordinator, for helping to collect and organize a portion of the raw data used in this study.
References (30)
- et al.
Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis
Gastroenterology
(1992) - et al.
Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay
Gastrointest Endosc
(1999) - et al.
Angiography in poorrisk patients with massive nonvariceal upper gastrointestinal bleeding
Am J Surg
(1990) - et al.
Quality improvement guidelines for percutaneous transcatheter embolization: SCVIR Standards of Practice Committee—Society of Cardiovascular and Interventional Radiology
J Vasc Interv Radiol
(1997) - et al.
Synchronous embolization of the gastroduodenal artery and the inferior pancreaticoduodenal artery in patients with massive duodenal hemorrhage
J Vasc Interv Radiol
(1995) Hepatic artery embolization for bleeding and tumors
Surg Clin North Am
(1989)- et al.
Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen
Am J Surg
(1999) - et al.
Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment
J Vasc Interv Radiol
(2001) - et al.
A comparison of omeprazole and placebo for bleeding peptic ulcer
N Engl J Med
(1997) - et al.
A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy
Arch Intern Med
(1998)
Management and outcome of patients undergoing surgery after acute upper gastrointestinal haemorrhage: steering group for the National Audit of Acute Upper Gastrointestinal Haemorrhage
J R Soc Med
Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding. Five years' experience in a central hospital
Scand J Gastroenterol
Selective arterial embolization: a new method for control of acute gastrointestinal bleeding
Radiology
Gastric bleeding sites: an angiographic study
Radiology
Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization
AJR Am J Roentgenol
Cited by (0)
- 1
Current address: Department of Radiology, The Reading Hospital and Medical Center, Reading, PA.