Taina Nykänen1, Erno Peltola2, Leena Kylänpää3, Marianne Udd3. 1. Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland. taina.nykanen@hus.fi. 2. Helsinki University Hospital, Helsinki Medical Imaging Center, Helsinki, Finland. 3. Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland.
Abstract
PURPOSE: To evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB). METHODS: Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004-2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates (≤ 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival. RESULTS: During the study period, angiography for LGIB was necessary on 123 patients. Out of 123, 55 (45%) underwent embolization attempts. TAE was technically successful in 53 (96%). Rebleeding occurred in 14 (26%). The complication rate was 36%, minor complications occurring in 10 (19%) and major in nine (17%). Major complications resulted in bowel resection in seven (13%). Post embolization ischemia was the most common single complication seen in nine (17%). The mortality rate was 6%. Survival estimates of 1 and 5 years were 79 and 49%. DISCUSSION: LGIB is a severe physiological insult occurring in patients who are often elderly and moribund. Although major post embolization complications occur, transcatheter arterial embolization should be the first-line approach over surgery in profuse LGIB in patients with hemodynamic instability, when colonoscopy fails or is unavailable, or when computerized tomography angiography detects small intestinal bleeding.
PURPOSE: To evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB). METHODS: Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004-2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates (≤ 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival. RESULTS: During the study period, angiography for LGIB was necessary on 123 patients. Out of 123, 55 (45%) underwent embolization attempts. TAE was technically successful in 53 (96%). Rebleeding occurred in 14 (26%). The complication rate was 36%, minor complications occurring in 10 (19%) and major in nine (17%). Major complications resulted in bowel resection in seven (13%). Post embolization ischemia was the most common single complication seen in nine (17%). The mortality rate was 6%. Survival estimates of 1 and 5 years were 79 and 49%. DISCUSSION: LGIB is a severe physiological insult occurring in patients who are often elderly and moribund. Although major post embolization complications occur, transcatheter arterial embolization should be the first-line approach over surgery in profuse LGIB in patients with hemodynamic instability, when colonoscopy fails or is unavailable, or when computerized tomography angiography detects small intestinal bleeding.
Authors: John F Angle; Nasir H Siddiqi; Michael J Wallace; Sanjoy Kundu; LeAnn Stokes; Joan C Wojak; John F Cardella Journal: J Vasc Interv Radiol Date: 2010-10 Impact factor: 3.464
Authors: C Bua-Ngam; J Norasetsingh; T Treesit; B Wedsart; O Chansanti; J Tapaneeyakorn; T Panpikoon; S A-O Vallibhakara Journal: Diagn Interv Imaging Date: 2017-03-22 Impact factor: 4.026
Authors: Geert Maleux; Filip Roeflaer; Sam Heye; Jo Vandersmissen; Anne-Sophie Vliegen; Ingrid Demedts; Alexander Wilmer Journal: Am J Gastroenterol Date: 2009-05-19 Impact factor: 10.864
Authors: D C Koh; M A Luchtefeld; D G Kim; M F Knox; B C Fedeson; J S Vanerp; B R Mustert Journal: Colorectal Dis Date: 2008-04-28 Impact factor: 3.788