Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization

Abstract

Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

Figure 1

(a) Selective arteriogram of gastroduodenal artery demonstrates active bleeding from superior pancreaticoduodenal branch. (b) Postembolization arteriogram showed complete exclusion of the bleeding vessel by multiple platinum coils.

Figure 2

(a) Selective ileocolic artery angiogram demonstrates intraluminal extravasation of contrast in caecum. (b) Postembolization arteriogram after selective embolization shows total occlusion of feeding vessel and cessation of hemorrhaging.