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Embolization as a First Approach with Endoscopically Unmanageable Acute Nonvariceal Gastrointestinal Hemorrhage¹

¹ From the Departments of Radiology and Medical Imaging (L.D., P.V., M.K.), Gastroenterology (M.D.V.), Abdominal Surgery (P.P., R.T.), Medical Informatics and Statistics (G.V.M.), and Intensive Care (J.D.), University Hospital of Gent, De Pintelaan 185, B-9000 Gent, Belgium. Received November 24, 1999; revision requested January 14, 2000; revision received June 9; accepted July 11. Address correspondence to L.D. (e-mail: Luc.Defreyne@rug.ac.be).

PURPOSE: To determine technical and clinical results of embolization of endoscopically unmanageable nonvariceal gastrointestinal hemorrhage (GIH).

MATERIALS AND METHODS: Results of 40 embolizations in 91 patients who underwent arteriography for acute nonvariceal GIH were retrospectively studied. GIH was upper, lower, or transpapillar (hemobilia, pancreatic duct bleeding). Clinical parameters and embolization data were assessed for clinical success and in-hospital survival.

RESULTS: Technical success (bleeding target devascularization) was achieved in all patients except one with upper GIH (39 [98%] of 40 patients). No bowel complications occurred. One partial liver lobe and one partial spleen infarction were noted. Five (13%) of 39 patients bled again within 3 days; all had upper GIH (P = .049). Clinical success (no rebleeding after 30 days) was achieved in 32 (82%) of 39 patients. Clinical success occurred in 13 (68%) of 19 patients with upper GIH, in 10 (91%) of 11 with lower GIH, and in all with transpapillar GIH (P = .084). Mortality rate was 28% (11 of 40 patients), equally spread over upper, lower, and transpapillar GIH (P = .87). Blood loss (hemoglobin level < 80 g/L, P = .041), use of packed cells (P = .049) and fresh frozen plasma (P = .006); shock (P = .047); and corticosteroid use (P = .036) were related to rebleeding. Shock (P = .039) and use of fresh frozen plasma (P = .003) before embolization and rebleeding (P =.012), coagulopathy (P = .007), and need for surgery (P = .03) after embolization were strongly correlated with mortality.

CONCLUSION: Embolization is an effective first approach with lower and transpapillar GIH after endoscopy; it was less effective with upper GIH.

Index terms: Endoscopy, 70.1269 • Gastrointestinal tract, angiography, 70.124 • Gastrointestinal tract, hemorrhage, 70.719 • Gastrointestinal tract, interventional procedures, 70.1264 • Gastrointestinal tract, surgery, 70.45

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