Original article—alimentary tract
Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding

https://doi.org/10.1016/j.cgh.2009.02.003Get rights and content

Background & Aims

Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been proposed but factors that influence the angiographic outcome are not well documented. We aimed to identify predictors of recurrent bleeding within 30 days after transcatheter embolization for refractory hemorrhage from gastroduodenal ulcers.

Methods

This retrospective single-center study of 60 consecutive emergency embolization procedures included hemodynamically unstable patients (41 men, 19 women; mean age, 69.4 ± 15 y), referred from 1999 to 2008 for selective angiography after failed endoscopic treatment. Predictors of early rebleeding were tested with univariate analysis and a multivariate logistic regression model.

Results

The procedural success rate was 95%, the primary clinical success rate was 71.9% (41 of 57), and secondary clinical success was achieved in 3 patients (77.2%) after repeat embolization. No major catheterization-related complications occurred. Periprocedural mortality was 26.7% (16 of 60). Early bleeding recurrence was associated with coagulation disorders (P = .007), longer time to angiography (P = .0005), greater preprocedural blood transfusion volume (P = .0009), 2 or more comorbidities (P = .005), and use of only coils (P = .003). Two factors were independent predictors of embolization failure: coagulation disorders (odds ratio, 6.18; P = .027) and the use of coils as the only embolic agent (odds ratio, 6.24; P = .022). The median follow-up time was 7 months (range, 1 day to 103 months).

Conclusions

Angiographic embolization should be performed early in the course of bleeding, and not with coils alone, in critically ill patients. It is important to correct coagulation disorders throughout the embolization procedure.

Section snippets

Patient Selection

We retrospectively reviewed the medical records of all patients who underwent angiographic embolization for refractory bleeding from gastroduodenal ulcers from October 1999 to January 2008 at our institution. Patients were identified using the database maintained prospectively by our Interventional Radiology Department. Patients with hemobilia or bleeding from varices, malignancies, or traumatic lesions were excluded. We identified 63 angiographic embolization procedures in 60 consecutive

Patient Characteristics

We reviewed 63 consecutive embolization procedures in 60 patients. There were 41 men and 19 women with a mean age of 69.4 years (range, 29–95 y). Most of the patients had a high surgical risk related to advanced age and comorbidities. Thus, 61.7% (37 of 60) of patients were older than 70 years, 38.3% (23 of 60) were older than 75 years, and 23.3% (14 of 60) were older than 80 years. Of the 60 patients, 54 (90%) had at least one serious comorbid condition and 25 (42%) had at least 2 comorbid

Discussion

Although sonography has been used as a diagnostic tool, with visualization of an intragastric clot being taken as evidence of bleeding,15 endoscopy remains the first-line method for diagnosing and treating actively bleeding peptic ulcers because its success rate is high. Recent advances in endoscopic hemostasis techniques ensure bleeding control in most patients. Endoscopic treatment is particularly valuable in patients whose advanced age or comorbid conditions pose a high surgical risk. When

References (29)

  • M.L. Goldman et al.

    Transcatheter therapeutic embolization in the management of massive upper gastrointestinal bleeding

    Radiology

    (1976)
  • B. Dousset et al.

    Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality

    Gastroenterol Clin Biol

    (1995)
  • C. Rollhauser et al.

    Nonvariceal upper gastrointestinal bleeding: an update

    Endoscopy

    (1997)
  • P. Qvist et al.

    Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding: five year's experience in a central hospital

    Scand J Gastroenterol

    (1994)
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    Conflicts of interest The authors disclose no conflicts.

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