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. 2017 Mar 23:17:27-32.
doi: 10.1016/j.amsu.2017.03.022. eCollection 2017 May.

The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding

Bryan Soh  1 , Steven Chan  2
Affiliations

The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding

Bryan Soh et al. Ann Med Surg (Lond). .

Retraction in

Abstract

Introduction: In this study, we aim to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolisation in managing lower gastrointestinal bleeding (LGIB) at a multi-centre health service in Melbourne (Australia).

Method: A retrospective case series of patients with LGIB treated with superselective embolisation in our area health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multi-detector CT angiography (CE-MDCT), were referred for DSA, and subsequently endovascular intervention. Data collected included patient characteristics; screening modality; bleeding territory; embolisation technique; technical and clinical success; short to mediumterm complications and mortality up to 30 days; and the need for surgery related to procedural failure or complications.

Results: There were 55 hospital admissions with acute unstable lower gastrointestinal bleeding that were demonstrable on CE-MDCT or RS over a 30-month period (from 1 January 2014 to 30 June 2016). Of these, eighteen patients were embolised. Immediate haemostasis was achieved in all embolised cases. Eight patients (44%) had clinical re-bleeding postembolisation and warranted repeated imaging. However, only one case (5.6%) had active bleeding identified and was re-embolised. There was no documented case of bowel ischemia or ischemic-stricture and none progressed on to surgery. 30 day mortality was zero.

Conclusion: Super-selective mesenteric embolisation is a viable, safe and effective first line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted first-line practice at our institution to manage localised LGIB with embolisation.

Keywords: Angiography; Lower gastrointestinal bleeding; Mesenteric embolisation.

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Figures

Fig. 1
Fig. 1
Presumptive aetiology of LGIB.
Fig. 2
Fig. 2
Diagnostic imaging modality performed.
Fig. 3
Fig. 3
Localised Bleeding Sites of all 18 cases by vascular territory.
Fig. 4
Fig. 4
Super-selective embolisation: a) before and b) after coil deployment.
See this image and copyright information in PMC

References

    1. Edelman D.A., Sugawa C. Lower gastrointestinal bleeding: a review. Surg. Endosc. 2007;21:514–520. - PubMed
    1. Barnert J., Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat. Rev. Gastroenterol. Hepatol. 2009;6:637–646. - PubMed
    1. Farrell J.J., Friedman L.S. Review article: the management of lower gastrointestinal bleeding. Alim. Pharmacol. Ther. 2005;21:1281–1298. - PubMed
    1. Funaki B. Superselective embolisation of lower gastrointestinal hemorrhage: a new paradigm. Abdom. Imaging. 2004;29:434–438. - PubMed
    1. Agha R.A., Fowler A.J., Rammohan S., Barai I. Orgill DP and the PROCESS group. The PROCESS statement: preferred reporting of case series in surgery. Int. J. Surg. 2016;36(Pt A):319–323. - PubMed

Further readings

    1. D'Othee B.J., Surapaneni P., Rabkin D., Nasser I., Clouse M. Microcoil embolization of acute lower gastrointestinal bleeding. Cardiovasc. Intervent. Radiol. 2006;29:49–58. - PubMed
    1. Karanicolas P.J., Colquhoun P.H., Dahlke E., Guyatt G.H. Mesenteric angiography for the localization and treatment of acute lower gastrointestinal bleeding. Can. J. Surg. 2008;51(6):437–441. - PMC - PubMed
    1. Koh D.C., Luchtefeld M.A., Kim D.G., Knox M.F., Fedeson B.C., VenErp J.S., Mustert B.R. Efficacy of transarterial embolisation as definitive treatment on lower gastrointestinal bleeding. Colorectal Dis. 2008;11:53–59. - PubMed
    1. Kramer S.C., Gorich J., Rilinger N., Siech M., Aschoff A.J., Vogel J., Brambs H.J. Embolization for gastrointestinal hemorrhages. Eur. Radiol. 2000;10:802–805. - PubMed
    1. Kwak H.S., Han Y.M., Lee S.T. The clinical outcomes of transcatheter microcoil embolisation in patients with active lower gastrointestinal bleeding in the small bowel. Korean J. Radiol. 2009;10:391–397. - PMC - PubMed

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