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Tiralongo F, Perini D, Crimi L, Taninokuchi Tomassoni M, Braccischi L, Castiglione DG, Modestino F, Vacirca F, Falsaperla D, Libra FMR, Palmucci S, Foti PV, Lionetti F, Mosconi C, Basile A. Transarterial embolization for acute lower gastrointestinal bleeding: a retrospective bicentric study. LA RADIOLOGIA MEDICA 2025:10.1007/s11547-025-02012-z. [PMID: 40249451 DOI: 10.1007/s11547-025-02012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 03/25/2025] [Indexed: 04/19/2025]
Abstract
Transcatheter arterial embolization (TAE) represents an effective treatment option for acute lower gastrointestinal bleeding (LGIB). This retrospective, bicentric study evaluated the safety and efficacy of TAE in 77 patients with LGIB. The mean patient age was 68.39 ± 17.54 years, and the mean pre-procedural hemoglobin was 7.87 ± 1.89 g/dL. The most common cause of LGIB was angiodysplasia (36.2%). Pre-procedural computed tomography angiography (CTA) detected active bleeding in 83% of cases. Technical success was achieved in 98.7% of patients, and 30-day clinical success was achieved in 87%. The rebleeding rate was 13%, and the ischemic complication rate was 11.7%. There were no significant associations between clinical success and sex, age, coagulopathy, first-line management, active bleeding signs, culprit vessel, superior mesenteric artery, or time between CTA and digital subtraction angiography. TAE is a safe and effective procedure for LGIB, with high technical and acceptable clinical success rates. It should be considered a standard procedure in select patients, especially when endoscopic treatment is contraindicated or not feasible.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy.
| | - Daniele Perini
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Luca Crimi
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Makoto Taninokuchi Tomassoni
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Lorenzo Braccischi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Daniele Falsaperla
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Federica Maria Rosaria Libra
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Stefano Palmucci
- UOSD "IPTRA", Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Francesco Lionetti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123, Catania, Italy
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Winston K, Rezaprasga E, Wafa S. Intestinal Metastasis of Choriocarcinoma: A Case Report of a Rare Cause of Gastrointestinal Bleeding. Cureus 2025; 17:e82220. [PMID: 40370905 PMCID: PMC12076091 DOI: 10.7759/cureus.82220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2025] [Indexed: 05/16/2025] Open
Abstract
Choriocarcinoma is widely known as an aggressive gestational trophoblastic disease characterized by rapid proliferation and early hematogenous spread. Gastrointestinal metastases, particularly to the small intestine, are rare but can lead to life-threatening complications such as ulceration, perforation, and massive bleeding. This case report describes intestinal metastasis of choriocarcinoma in a 30-year-old patient presenting with chronic hematochezia, progressive pallor, unintentional weight loss over three months, and left lower abdominal pain. Previously, the patient had a molar pregnancy, which was removed via dilation and curettage procedure, but no subsequent follow-up and examinations were conducted post-operation. Physical examination revealed conjunctival pallor and a palpable mass in the left lower quadrant, with rectal examination confirming active bleeding. Chest X-ray revealed multiple pulmonary nodules, and ultrasound revealed abdomen liver metastasis and irregular mass in the lower abdomen. The same mass was confirmed by CT scan of the abdomen. During hospitalization, the patient experienced recurrent GI bleeding, necessitating multiple blood transfusions. Colonoscopy identified an actively bleeding mass in the terminal ileum, and an abdominal CT scan confirmed a large abdominal mass. Extremely elevated levels of hCG (>1,000,000 mIU/mL) supported the diagnosis of metastatic gestational trophoblastic cancer with subsequent histopathological analysis confirmed metastatic choriocarcinoma. Given the persistent hemorrhage, surgical intervention was performed, but the patient developed postoperative sepsis and succumbed to the illness. Although choriocarcinoma is highly treatable with chemotherapy, atypical metastases to the gastrointestinal tract can complicate diagnosis and management, leading to severe complications. This case emphasizes the importance of considering choriocarcinoma in the differential diagnosis of unexplained GI bleeding in patients with a history of gestational trophoblastic disease.
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Affiliation(s)
- Kevin Winston
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, IDN
| | - Edo Rezaprasga
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, IDN
| | - Syahidatul Wafa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, IDN
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Liang HL, Chiang CL, Li MF. Empiric embolization by vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report. Sci Rep 2024; 14:25728. [PMID: 39468181 PMCID: PMC11519608 DOI: 10.1038/s41598-024-76408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 10/14/2024] [Indexed: 10/30/2024] Open
Abstract
To report the preliminary result of empiric embolization for angiographycally-negative lower gastrointestinal bleeding (LGIB) by using the pharmaco-induced vasospasm technique with or without the adjunctive use of intra-arterial multi-detector computed tomography (MDCT). 23 LGIB patients with positive MDCT findings but negative angiographic results underwent empiric pharmaco-induced vasospasm therapy. The presumed bleeding artery was semi-selectively catheterized, and a segment of bowel was temporarily spasmed with bolus injection of epinephrine and immediately followed by 4-h' vasopressin infusion. The rebleeding, primary and overall clinical success rates were reported. MDCT showed 19 bleeders in the SMA territory and 4 bleeders in the IMA territory. Early rebleeding was found in 6 patients (26.1%): 2 local rebleeding, 3 from new-foci bleeding and 1 uncertain. Of the 10 small bowel bleeding patients, only 1 out of the 7 who underwent intra-arterial MDCT showed rebleeding, whereas 2 out of the 3 without intra-arterial MDCT rebled. No patients exhibited procedure-related major complications, including bowel ischemia and cardiopulmonary distress. The overall clinical success rate was 91.3% (21/23) with a 30-day mortality rate of 26.1% (2 of the 6 patients had early rebleeding). Empiric pharmaco-induced vasospasm therapy, when localized with/without adjunctive intra-arterial MDCT, seems to be a safe and effective method to treat angiographically-negative LGIB patients.
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Affiliation(s)
- Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- Interventional Center, Antai Tian-Sheng Memorial Hospital, Donggang, Taiwan.
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
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Yu Q, Funaki B, Ahmed O. Twenty years of embolization for acute lower gastrointestinal bleeding: a meta-analysis of rebleeding and ischaemia rates. Br J Radiol 2024; 97:920-932. [PMID: 38364312 PMCID: PMC11075984 DOI: 10.1093/bjr/tqae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Transarterial embolization (TAE) for acute lower gastrointestinal bleeding (LGIB) can be technically challenging due to the compromise between achieving haemostasis and causing tissue ischaemia. The goal of the present study is to determine its technical success, rebleeding, and post-embolization ischaemia rates through meta-analysis of published literature in the last twenty years. METHODS PubMed, Embase, and Cochrane Library databases were queried. Technical success, rebleeding, and ischaemia rates were extracted. Baseline characteristics such as author, publication year, region, study design, embolization material, percentage of superselective embolization were retrieved. Subgroup analysis was performed based on publication time and embolization agent. RESULTS A total of 66 studies including 2121 patients who underwent embolization for acute LGIB were included. Endoscopic management was attempted in 34.5%. The pooled overall technical success, rebleeding, post-embolization ischaemia rates were 97.0%, 20.7%, and 7.5%, respectively. Studies published after 2010 showed higher technical success rates (97.8% vs 95.2%), lower rebleeding rates (18.6% vs 23.4%), and lower ischaemia rates (7.3% vs 9.7%). Compared to microcoils, NBCA was associated with a lower rebleeding rate (9.3% vs 20.8%) at the expense of a higher post-embolization ischaemia rate (9.7% vs 4.0%). Coagulopathy (P = .034), inotropic use (P = .040), and malignancy (P = .002) were predictors of post-embolization rebleeding. Haemorrhagic shock (P < .001), inotropic use (P = .026), malignancy (P < .001), coagulopathy (P = .002), blood transfusion (P < .001), and enteritis (P = .023) were predictors of mortality. Empiric embolization achieved a similarly durable haemostasis rate compared to targeted embolization (23.6% vs 21.1%) but a higher risk of post-embolization ischaemia (14.3% vs 4.7%). CONCLUSION For LGIB, TAE has a favourable technical success rate and low risk of post-embolization ischaemia. Its safety and efficacy profile has increased over the last decade. Compared to microcoils, NBCA seemed to offer a more durable haemostasis rate at the expense of higher ischaemia risk. Due to the heterogeneity of currently available evidence, future prospective and comparative studies are warranted. ADVANCES IN KNOWLEDGE (1) Acute LGIB embolization demonstrate a high technical success rate with acceptable rate of rebleeding and symptomatic ischaemia rates. Most ischaemic stigmata discovered during routine post-embolization colonoscopy were minor. (2) Although NBCA seemed to offer a more durable haemostasis rate, it was also associated with a higher risk of ischaemia compared to microcoils. (3) Coagulopathy, malignant aetiology, and inotropic use were predictors of rebleeding and mortality. (4) Routine post-embolization endoscopy to assess for ischaemia is not indicated.
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Affiliation(s)
- Qian Yu
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, 33331, United States
| | - Brian Funaki
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
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Omori J, Kaise M, Nagata N, Aoki T, Kobayashi K, Yamauchi A, Yamada A, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Hikichi T, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Iwakiri K. Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases. J Gastroenterol 2024; 59:24-33. [PMID: 38006444 DOI: 10.1007/s00535-023-02057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Current evidence on the surgical rate, indication, procedure, risk factors, mortality, and postoperative rebleeding for acute lower gastrointestinal bleeding (ALGIB) is limited. METHODS We constructed a retrospective cohort of 10,342 patients admitted for acute hematochezia at 49 hospitals (CODE BLUE J-Study) and evaluated clinical data on the surgeries performed. RESULTS Surgery was performed in 1.3% (136/10342) of the cohort with high rates of colonoscopy (87.7%) and endoscopic hemostasis (26.7%). Indications for surgery included colonic diverticular bleeding (24%), colorectal cancer (22%), and small bowel bleeding (16%). Sixty-four percent of surgeries were for hemostasis for severe refractory bleeding. Postoperative rebleeding rates were 22% in patients with presumptive or obscure preoperative identification of the bleeding source and 12% in those with definitive identification. Thirty-day mortality rates were 1.5% and 0.8% in patients with and without surgery, respectively. Multivariate analysis showed that surgery-related risk factors were transfusion need ≥ 6 units (P < 0.001), in-hospital rebleeding (P < 0.001), small bowel bleeding (P < 0.001), colorectal cancer (P < 0.001), and hemorrhoids (P < 0.001). Endoscopic hemostasis was negatively associated with surgery (P = 0.003). For small bowel bleeding, the surgery rate was significantly lower in patients with endoscopic hemostasis as 2% compared to 12% without endoscopic hemostasis. CONCLUSIONS Our cohort study elucidated the outcomes and risks of the surgery. Extensive exploration including the small bowel to identify the source of bleeding and endoscopic hemostasis may reduce unnecessary surgery and improve the management of ALGIB.
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Affiliation(s)
- Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Ken Kinjo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
- Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
| | | | - Tomohiro Funabiki
- Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
- Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan
| | - Yuzuru Kinjo
- Department of Gastroenterology, Naha City Hospital, Okinawa, Japan
| | - Akira Mizuki
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuto Hikichi
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuga Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Tari E, Frim L, Stolcz T, Teutsch B, Veres DS, Hegyi P, Erőss B. At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: a systematic review and meta-analysis. Therap Adv Gastroenterol 2023; 16:17562848231190970. [PMID: 37655056 PMCID: PMC10467304 DOI: 10.1177/17562848231190970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding (GIB) is a life-threatening event. Around 20-30% of patients with GIB will develop hemodynamic instability (HI). OBJECTIVES We aimed to quantify HI as a risk factor for the development of relevant end points in acute GIB. DESIGN A systematic search was conducted in three medical databases in October 2021. DATA SOURCES AND METHODS Studies of GIB patients detailing HI as a risk factor for the investigated outcomes were selected. For the overall results, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on a random-effects model. Subgroups were formed based on the source of bleeding. The Quality of Prognostic Studies tool was used to assess the risk of bias. RESULTS A total of 62 studies were eligible, and 39 were included in the quantitative synthesis. HI was found to be a risk factor for both in-hospital (OR: 5.48; CI: 3.99-7.52) and 30-day mortality (OR: 3.99; CI: 3.08-5.17) in upper GIB (UGIB). HI was also associated with higher in-hospital (OR: 3.68; CI: 2.24-6.05) and 30-day rebleeding rates (OR: 4.12; 1.83-9.31) among patients with UGIB. The need for surgery was also more frequent in hemodynamically compromised UGIB patients (OR: 3.65; CI: 2.84-4.68). In the case of in-hospital mortality, the risk of bias was high for 1 (4%), medium for 13 (48%), and low for 13 (48%) of the 27 included studies. CONCLUSION Hemodynamically compromised patients have increased odds of all relevant untoward end points in GIB. Therefore, to improve the outcomes, adequate emergency care is crucial in HI. REGISTRATION PROSPERO registration number: CRD42021285727.
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Affiliation(s)
- Edina Tari
- Centre for Translational Medicine, Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Levente Frim
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tünde Stolcz
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Tömő u. 25.-29., Budapest, 1083, Hungary
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Obeidat M, Teutsch B, Rancz A, Tari E, Márta K, Veres DS, Hosszúfalusi N, Mihály E, Hegyi P, Erőss B. One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability: A systematic review and meta-analysis. World J Gastroenterol 2023; 29:4466-4480. [PMID: 37576706 PMCID: PMC10415974 DOI: 10.3748/wjg.v29.i28.4466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding. However, there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding. AIM To determine the pooled event rates in the available literature and specify them based on the bleeding source. METHODS The protocol was registered on PROSPERO in advance (CRD42021283258). A systematic search was performed in three databases (PubMed, EMBASE, and CENTRAL) on 14th October 2021. Pooled proportions with 95%CI were calculated with a random-effects model. A subgroup analysis was carried out based on the time of assessment (on admission or during hospital stay). Heterogeneity was assessed by Higgins and Thompson's I2 statistics. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment. The Reference Citation Analysis (https://www.referencecitationanalysis.com/) tool was applied to obtain the latest highlight articles. RESULTS We identified 11589 records, of which 220 studies were eligible for data extraction. The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25 (95%CI: 0.17-0.36, I2 = 100%). In non-variceal bleeding, the proportion was 0.22 (95%CI: 0.14-0.31, I2 = 100%), whereas it was 0.25 (95%CI: 0.19-0.32, I2 = 100%) in variceal bleeding. The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12 (95%CI: 0.06-0.22, I2 = 90%). The risk of bias was low, and heterogeneity was high in all analyses. CONCLUSION One in five, one in four, and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal, variceal, and colonic diverticular bleeding, respectively.
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Affiliation(s)
- Mahmoud Obeidat
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary
| | - Anett Rancz
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Department of Internal Medicine and Hematology, Semmelweis University, Faculty of Medicine, Budapest 1085, Hungary
| | - Edina Tari
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
| | - Katalin Márta
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest 1085, Hungary
| | - Nóra Hosszúfalusi
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Department of Internal Medicine and Hematology, Semmelweis University, Faculty of Medicine, Budapest 1085, Hungary
| | - Emese Mihály
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Department of Internal Medicine and Hematology, Semmelweis University, Faculty of Medicine, Budapest 1085, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
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8
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Torkian P, Jalaeian H, Wallace S, Shrestha P, Talaie R, Golzarian J. Post-Embolization Hemoglobin Changes: When to Consider Re-intervention. Cardiovasc Intervent Radiol 2023; 46:617-625. [PMID: 36869220 DOI: 10.1007/s00270-023-03386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Decline in hemoglobin (Hgb) levels is common post-embolization, but there is no consensus on the classification of patients based on risk for re-bleeding or re-intervention. The current study evaluated post-embolization Hgb level trends with the goal of understanding the factors predictive of re-bleeding and re-intervention. MATERIALS AND METHODS All patients who underwent embolization for gastrointestinal (GI), genitourinary, peripheral, or thoracic arterial hemorrhage from 01/2017 to 01/2022 were reviewed. Data included demographics, periprocedural pRBC transfusion (TF) or pressor requirements, and outcome. Lab data consisted of Hgb values pre-embolization, immediately post-embolization, and daily values on days 1-10 after embolization. Hgb trends were compared between patients across TF and re-bleeding outcomes. Regression model was used to examine factors predictive of re-bleeding and magnitude of Hgb reduction post-embolization. RESULTS A total of 199 patients were embolized for active arterial hemorrhage. Perioperative Hgb level trends were similar for all sites and between TF + and TF- patients, showing a decline reaching a nadir within 6 days post-embolization followed by an upward trend. Maximum Hgb drift was predicted by GI embolization (p = 0.018), TF before embolization (p = 0.001), and use of vasopressor (p = 0.000). Patients with Hgb drop > 15% within the first two days post-embolization had a higher chance of having a re-bleeding episode (p = 0.04). CONCLUSION Perioperative Hgb trends showed a consistent downward drift followed by an upward shift, irrespective of TF requirement status or site of embolization. Using a cut-off value of 15% Hgb reduction within the first two days post-embolization may be helpful to assess re-bleeding risk.
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Affiliation(s)
- Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Hamed Jalaeian
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Stephanie Wallace
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Prashant Shrestha
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
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9
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Eqbal H, Owen A, Guest G, Watters D, Nagra S. Small bowel resection for ischemia following transcatheter arterial embolization for bleeding jejunal diverticulum: an easily forgotten complication. ANZ J Surg 2022; 93:1027-1028. [PMID: 36107114 DOI: 10.1111/ans.18042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Henna Eqbal
- Department of Surgery University Hospital Geelong Geelong Australia
| | - Andrew Owen
- Department of Radiology University Hospital Geelong Geelong Australia
| | - Glenn Guest
- Department of Surgery University Hospital Geelong Geelong Australia
| | - David Watters
- Department of Surgery University Hospital Geelong Geelong Australia
| | - Sonal Nagra
- Department of Surgery University Hospital Geelong Geelong Australia
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10
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Li MF, Liang HL, Chiang CL, Lin YH. Management of acute lower gastrointestinal bleeding by pharmaco-induced vasospasm embolization therapy. J Chin Med Assoc 2022; 85:233-239. [PMID: 35175244 DOI: 10.1097/jcma.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To report the clinical outcomes of vasospasm embolization technique in treating lower gastrointestinal bleeding (LGIB). METHODS Fifty LGIB patients (32 men and 18 women; mean age, 70.4 years) with positive contrast extravasation on multidetector computed tomography were treated with pharmaco-induced vasospasm embolization by semiselective catheterization technique. Distal rectal bleeding was excluded. The bleedings in three patients were considered to be tumor related. Eighteen underwent regular hemodialysis, and 22 showed unstable hemodynamic at intervention. RESULTS Forty-two bleeders were found in superior mesenteric territory and eight in the inferior mesenteric territory. Successful, immediate hemostasis was achieved in 49 (98%) patients. Early recurrent bleeding (<30 days) was found in 13 (26.5%) patients with 6 local rebleeding (12.2%), 5 new-foci bleeding (10.2%), and 2 uncertain foci bleeding (4.1%). Repeated vasospasm embolization therapy was given to five patients, with successful hemostasis in four. All the three tumor-related bleeding patients undergoing vasospasm embolization had ceased bleeding and discharged. Patient-based primary and overall clinical successes were achieved in 73.5% and 83.7%, and lesion-based primary and overall clinical successes were 83.0% and 86.7%, respectively. The 30-day mortality rate was 21.3%, and the 1- and 2-year survival rates were 51.5% and 43.8%. No major procedure-related complications (eg, bowel ischemia) were encountered. CONCLUSION This study confirmed our prior preliminary conclusion that pharmaco-induced vasospasm embolization is easy, safe, and effective for LGIB. This treatment may be considered the first-line alternative approach for LGIB, especially for patients of advanced age with complex medical problems and/or when vasa rectal embolization isn't feasible.
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Affiliation(s)
- Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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11
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Extrat C, Grange S, Chevalier C, Williet N, Phelip JM, Barral FG, Le Roy B, Grange R. Safety and efficacy of emergency transarterial embolization for mesenteric bleeding. CVIR Endovasc 2022; 5:5. [PMID: 34997883 PMCID: PMC8742795 DOI: 10.1186/s42155-021-00281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.
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Affiliation(s)
- Chloé Extrat
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Clément Chevalier
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Nicolas Williet
- Department of Gastro-Enterology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Jean-Marc Phelip
- Department of Gastro-Enterology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Fabrice-Guy Barral
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France
| | - Bertrand Le Roy
- Department of Digestive and oncologic surgery, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-En-Jarez, France.
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12
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Seyferth E, Dai R, Ronald J, Martin JG, Sag AA, Befera N, Pabon-Ramos WM, Suhocki PV, Smith TP, Kim CY. Safety Profile of Particle Embolization for Treatment of Acute Lower Gastrointestinal Bleeding. J Vasc Interv Radiol 2021; 33:286-294. [PMID: 34798292 DOI: 10.1016/j.jvir.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/21/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess ischemic adverse events following particle embolization when used as a second-line embolic to coil embolization for treatment of acute lower gastrointestinal bleeding(LGIB). MATERIALS AND METHODS This single-institution retrospective study examined 154 procedures where embolization was attempted for LGIB. In 122 patients (64 males, mean age 69.9 years), embolization was successfully performed using microcoils in 73 procedures, particles in 34 procedures, and both microcoils and particles in 27 procedures. Particles were used as second-line only when coil embolization was infeasible or inadequate. Technical success was defined as angiographic cessation of active extravasation after embolization. Clinical success was defined as absence of recurrent bleeding within 30 days of embolization. RESULTS Technical success for embolization of LGIB was achieved in 87.0% of cases (134/154), and clinical success was 76.1%(102/134) among technically successful cases. Clinical success was 82.2%(60/73) for coils alone and 68.9%(42/61) for particles +/- coils. Severe adverse events involving embolization-induced bowel ischemia occurred in 3 of 56 patients who underwent particle embolization +/- coils (5.3%) versus zero out of 66 patients when coils alone were used (P=0.09). In patients who had colonoscopy or bowel resection within 2 weeks of embolization, ischemic findings attributable to the embolization were found in 3 of 15 who underwent embolization with coils alone, versus 8 of 18 who underwent embolization with particles +/- coils (p=0.27). CONCLUSION Particle embolization for treatment of LGIB as second line to coil embolization was associated with a 68.9% clinical success rate and a 5.3% rate of ischemia-related adverse events.
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Affiliation(s)
- Elisabeth Seyferth
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Rui Dai
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - James Ronald
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Jonathan G Martin
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Alan A Sag
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Nicholas Befera
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Waleska M Pabon-Ramos
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Paul V Suhocki
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Tony P Smith
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
| | - Charles Y Kim
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC 27710
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13
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Reitano E, de'Angelis N, Bianchi G, Laera L, Spiliopoulos S, Calbi R, Memeo R, Inchingolo R. Current trends and perspectives in interventional radiology for gastrointestinal cancers. World J Radiol 2021; 13:314-326. [PMID: 34786187 PMCID: PMC8567440 DOI: 10.4329/wjr.v13.i10.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/12/2021] [Accepted: 10/09/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, University of Eastern Piedmont, Novara 28100, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Letizia Laera
- Department of Oncology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Roberto Calbi
- Department of Radiology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
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14
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Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding. Eur Radiol 2020; 31:2161-2172. [PMID: 32964336 DOI: 10.1007/s00330-020-07232-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/17/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the clinical effect and safety of cone-beam CT (CBCT)-guided empirical embolization for acute lower gastrointestinal bleeding (LGIB) in patients with a positive CT angiography (CTA) but subsequent negative digital subtraction angiography (DSA). METHODS A retrospective study of consecutive LGIB patients with a positive CTA who received a DSA within 24 h from January 2008 to July 2019. Patients with a positive DSA were treated with targeted embolization (TE group). Patients with a negative DSA underwent an empiric CBCT-guided embolization of the assumed ruptured vas rectum (EE group) or no embolization (NE group). Recurrent bleeding, major ischemic complications, and in-hospital mortality were compared by means of Fisher's exact test. Further subgroup analysis was performed on hemodynamic instability. RESULTS Eighty-five patients (67.6 years ± 15.7, 52 men) were included (TE group, n = 47; EE group, n = 19; NE group, n = 19). If DSA was positive, technical success of targeted embolization was 100% (47/47). If DSA was negative and the intention to treat by empiric CBCT-guided embolization, technical success was 100% (19/19). Recurrent bleeding rates in the TE group, EE group, and NE group were 17.0% (8/47), 21.1% (4/19), and 52.6% (10/19) respectively. Empiric CBCT-guided embolization reduced rebleeding significantly in patients with a negative DSA and hemodynamic instability (EE group, 3/10 vs NE group, 10/12, p = .027). Major ischemic complications occurred in one patient (TE group). Overall, the in-hospital mortality rate was 7.1% (6/85). CONCLUSION Empiric cone-beam CT-guided embolization proved to be a feasible, effective, and safe treatment strategy to reduce rebleeding and improve clinical success in hemodynamically unstable patients with acute LGIB, positive CTA but negative DSA. KEY POINTS • A novel transarterial embolization technique guided by cone-beam CT could be developed extending the "empiric" embolization strategy to lower gastrointestinal bleeding. • By implementing the empiric treatment strategy, nearly all patients with an active lower gastrointestinal bleeding on CTA will be eligible for a superselective empiric embolization, even if subsequent catheter angiography is negative. • In patients with a negative catheter angiography, empiric embolization reduces the rebleeding rate and, particularly in hemodynamically unstable patients, improves clinical success compared with a conservative "wait-and-see" management.
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15
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Lai HY, Wu KT, Liu Y, Zeng ZF, Zhang B. Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding. Scand J Gastroenterol 2020; 55:931-940. [PMID: 32650690 DOI: 10.1080/00365521.2020.1790650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND GOALS Acute non-variceal gastrointestinal bleeding (NVGIB) is one of the most common medical emergencies, leading to significant morbidity and mortality without proper management. This study was to analyze the causes of NVGIB and to evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) for the treatment of NVGIB. STUDY From November 2012 to October 2018, 158 patients with NVGIB underwent digital subtraction angiography, and TAE was performed for confirmed gastrointestinal bleeding. Patient characteristics, cause of bleeding, angiographic findings, technical and clinical success rates, complication rates, and outcomes were retrospectively analyzed. RESULTS Bleeding was confirmed in 71.5% (113/158) of performed angiographies, and 68 patients had visible contrast extravasation on angiography, with the other 45 patients having indirect signs of bleeding. Among the 113 patients with confirmed gastrointestinal bleeding, TAE was technically successful in 111 patients (98.2%). The mean procedure time required for TAE was 116 ± 44 min (ranging from 50 to 225 min). The primary total clinical success rate of TAE was 84.7% (94/111). The primary clinical success rates of TAE for vascular abnormality, neoplastic disease, and iatrogenic condition were 84.5% (49/58), 84.1% (37/44), and 88.9% (8/9), respectively. Intestinal necrosis and perforation were found in two patients after TAE. CONCLUSIONS The causes of NVGIB are complex and the onset, location, risk, and clinical presentations are variable. NVGIB can be generally divided into three types: vascular abnormality, neoplastic disease, and iatrogenic condition. TAE is a safe, effective, and fast procedure in the management of gastrointestinal bleeding.
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Affiliation(s)
- Hai-Yang Lai
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke-Tong Wu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang Liu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhao-Fei Zeng
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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16
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Lv LS, Gu JT. Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage. World J Clin Cases 2019; 7:3728-3733. [PMID: 31799297 PMCID: PMC6887619 DOI: 10.12998/wjcc.v7.i22.3728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding is an emergency condition that can lead to significant morbidity and mortality. Embolization is considered the preferred therapy in the treatment of lower gastrointestinal bleeding when it is unrealistic to perform the surgery or vasopressin infusion in this population. Treatment of acute lower gastrointestinal (GI) bleeding (any site below the ligament of Treitz) using this technique has not reached a consensus, because of the belief that the risk of intestinal infarction in this condition is extremely high. The purpose of the study is to evaluate the effectiveness and safety of this technique in a retrospective group of patients who underwent embolization for acute lower GI bleeding.
AIM To evaluate the efficacy and safety of super-selective arterial embolization in the management of acute lower GI bleeding.
METHODS A series of 31 consecutive patients with angiographically demonstrated small intestinal or colonic bleeding was retrospectively reviewed. The success rate and complication rate of super-selective embolization were recorded.
RESULTS Five out of thirty-one patients (16.1%) could not achieve sufficiently selective catheterization to permit embolization. Initial control of bleeding was achieved in 26 patients (100%), and relapsed GI bleeding occurred in 1 of them at 1 wk after the operation. No clinically apparent bowel infarctions were observed in patients undergoing embolization.
CONCLUSION Super-selective embolization is a safe therapeutic method for acute lower GI bleeding, and it is suitable and effective for many patients suffering this disease. Importantly, careful technique and suitable embolic agent are essential to the successful operation.
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Affiliation(s)
- Liang-Shan Lv
- Department of Gastroenterology and Interventional Radiography, Xi’an Gaoxin Hospital, Xi’an Jiaotong University, Xi’an 710075, Shaanxi Province, China
| | - Jing-Tao Gu
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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17
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Shabunin AV, Bagateliya ZA, Korzheva IY, Lebedev SS, Gugnin AV, Tzurkan VA. [Optimization of surgical care for the hemorrhagic colorectal cancer]. Khirurgiia (Mosk) 2019:30-36. [PMID: 31120444 DOI: 10.17116/hirurgia201904130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To optimize surgical care for the hemorrhagic colorectal cancer. MATERIAL AND METHODS 77 patients diagnosed with hemorrhagic colorectal cancer were reviewed: 9 patients of them were efficaciously treated with conservative therapy (I group); 47 - underwent successful endoscopic coagulation (I); 4 - arterial embolization (I), 2 - ligation of internal iliac arteries (I), 15 - acute resection (II group). 20 of 62 patients I group underwent plan surgery and radiation or chemotherapy during 7-10 days after hemostasis and normalization hemoglobin. The 3-year cumulative survival after resections (acute versus plan) was plotted on a Kaplan-Meier chart in 31 patients. RESULTS Complications and postoperative mortality was significantly higher after acute resection (II group) compared with plan resection (I): 33,3% vs 20%; 15% vs 5%, respectively. The survival rate was higher after plan than acute resections: 0,8882 and 0,3571, respectively. CONCLUSION Acute surgery for hemorrhagic colorectal cancer should only be carried out by appropriately trained surgeons in multi-specialty hospital. Endoscopy and arterial embolization are the most effective means of successfully controlling hemorrhage while minimizing potential complications. A bridging strategy may be a valid alternative in some of patients with hemorrhagic colorectal cancer, because a significantly lower postoperative mortality rate.
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Affiliation(s)
- A V Shabunin
- Botkin Municipal Clinical Hospital, Moscow, Russian Federation; Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation
| | - Z A Bagateliya
- Botkin Municipal Clinical Hospital, Moscow, Russian Federation; Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation
| | - I Yu Korzheva
- Botkin Municipal Clinical Hospital, Moscow, Russian Federation; Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation
| | - S S Lebedev
- Botkin Municipal Clinical Hospital, Moscow, Russian Federation; Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation
| | - A V Gugnin
- Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation, Botkin Municipal Clinical Hospital, Moscow, Russian Federation
| | - V A Tzurkan
- Chair of Surgery of the Russian Medical Academy of Continuing Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russian Federation, Botkin Municipal Clinical Hospital, Moscow, Russian Federation
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