The clinical outcomes of transcatheter microcoil embolization in patients with active lower gastrointestinal bleeding in the small bowel

Abstract

Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography.

Materials and methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates.

Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure.

Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

Keywords: Angiography, microcoils; Gastrointestinal bleeding; Selective embolization.

Fig. 1

Treatment modalities for 36 patients with lower gastrointestinal hemorrhaging. Tx = treatment, pts = patients

Fig. 2

Results from 81-year-old woman with acute lower gastrointestinal bleeding. A. Selective arteriogram, obtained after coaxial advancement of catheter into right ileocolic artery, shows active hemorrhaging (arrow). B. Branch of right ileocolic artery has been embolized with single 3-2 mm microcoil (arrow). C. Postembolization arteriogram after superselective embolization shows total occlusion of feeding vessel and cessation of hemorrhaging.

Fig. 3

Results from 69-year-old male patient with acute lower gastrointestinal bleeding following surgical treatment of gastric cancer. A. Superior and inferior mesenteric arteriogram reveals no abnormal extravasation of contrast medium. B. Radionuclide scan with technetium 99m-labeled red blood cells, performed immediately due to continued bleeding, displays bleeding focus (arrow) from increased isotope uptake in left lower quadrant. C. Repeated angiogram does not show extravasation of contrast medium. Patient underwent conservative management and did not show any further bleeding one week later.