Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 13:12:3.
doi: 10.1186/s13017-016-0114-1. eCollection 2017.

Preventive transarterial embolization in upper nonvariceal gastrointestinal bleeding

Aleksejs Kaminskis  1 , Aina Kratovska  2 , Sanita Ponomarjova  2 , Anna Tolstova  1 , Maksims Mukans  1 , Solvita Stabiņa  1 , Raivis Gailums  1 , Andrejs Bernšteins  2 , Patricija Ivanova  2 , Viesturs Boka  3 , Guntars Pupelis  4
Affiliations

Preventive transarterial embolization in upper nonvariceal gastrointestinal bleeding

Aleksejs Kaminskis et al. World J Emerg Surg. .

Abstract

Background: Transarterial embolization (TAE) is a therapeutic option for patients with a high risk of recurrent bleeding after endoscopic haemostasis. The aim of our prospective study was a preliminary assessment of the safety, efficacy, and clinical outcomes following preventive TAE in patients with non-variceal acute upper gastrointestinal bleeding (NVUGIB) with a high risk of recurrent bleeding after endoscopic haemostasis.

Methods: Preventive visceral angiography and TAE were performed after endoscopic haemostasis on patients with NVUGIB who were at a high risk of recurrent bleeding (PE+ group). The comparison group consisted of similar patients who only underwent endoscopic haemostasis, without preventive TAE (PE- group). The technical success of preventive TAE, the completeness of haemostasis, the incidence of rebleeding and the need for surgical intervention and the main outcomes were compared between the groups.

Results: The PE+ group consisted of 25 patients, and the PE- group of 50 patients, similar in age (median age 66 vs. 63 years), gender and comorbid conditions. The ulcer size at endoscopy was not significantly different (median of 152 mm vs. 127 mm). The most frequent were Forest II type ulcers, 44% in both groups. The distribution of the Forest grade was even. The median haemoglobin on admission was 8, 2 g/dl vs. 8,7 g/dl, p = 0,482, erythrocyte count was 2,7 × 1012/L vs. 2,9 × 1012/L, p = 0,727. The shock index and Rockall scores were similar, as well as and transfusion - on average, four units of packed red blood cells for the majority of patients in both groups, however, significantly more fresh frozen plasma was transfused in the PE- group, p = 0,013. The rebleeding rate was similar, while surgical treatment was needed notably more often in the PE- group, 8% vs. 35% accordingly, p = 0,012. The median ICU stay was 3 days, hospital stay - 6 days vs. 9 days, p = 0.079. The overall mortality reached 20%; in the PE+ group it was 4%, not reaching a statistically significant difference.

Conclusion: Preventive TAE is a feasible, safe and effective minimally invasive type of haemostasis decreasing the risk of repeated bleeding and preparing the patient for the definitive surgical intervention when indicated.

Keywords: Nonvariceal upper gastrointestinal bleeding; Preventive embolization; Transarterial.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Patient recruitment chart
See this image and copyright information in PMC

References

    1. Loffroy RF, Abualsaud BA, Lin MD, Rao PP. Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding. World J Gastrointest Surg. 2011;3:89–100. doi: 10.4240/wjgs.v3.i7.89. - DOI - PMC - PubMed
    1. Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010;33:1088–1100. doi: 10.1007/s00270-010-9829-7. - DOI - PubMed
    1. Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19:1413–1418. doi: 10.1016/j.jvir.2008.06.019. - DOI - PubMed
    1. Wong TC, Wong KT, Chiu PW, Teoh AY, Yu SC, Au KW, et al. A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointest Endosc. 2011;73:900–908. doi: 10.1016/j.gie.2010.11.024. - DOI - PubMed
    1. Laursen SB, Hansen JM, Andersen PE, Schaffalitzky de muckadell OB. Supplementary arteriel embolization an option in high-risk ulcer bleeding–a randomized study. Scand J Gastroenterol. 2014;49:75–83. doi: 10.3109/00365521.2013.854829. - DOI - PubMed