Transcatheter arterial embolization for acute nonvariceal upper Gastrointestinal bleeding in children: a single-center retrospective study

Abstract

Objective: This study aims to provide a preliminary report on the outcomes of transcatheter arterial embolization (TAE) in pediatric patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB) to establish optimal practices for this intervention and explore its potential value in improving the management of pediatric patients.

Methods: A retrospective analysis was conducted on children with NVUGIB who underwent TAE at a single institutional center between February 2022 and April 2024. Comprehensive data were collected, including patient demographics, clinical manifestations, diagnostic and therapeutic procedures, intraoperative findings, and follow-up outcomes.

Results: A total of 266 cases with NVUGIB were admitted to the institutional center, with 14 cases (5.26%) undergoing TAE. There were 10 males and 4 females. The average age was 7.21 ± 4.77 years old, and the average hospital stay was 13.14 ± 8.69 days. Nine cases (64.29%) had hematochezia, 2 cases (14.29%) had hematemesis, 3 cases (21.42%) had both hematochezia and hematemesis. Six cases (42.86%) had no significant medical history, 3 cases (21.42%) had previous Helicobacter pylori infections, 2 cases (14.29%) had previous lymphomas, and 1 case (7.14%) each had immune disorders, gastroenteritis, and fever. The mean preoperative minimum hemoglobin level was 57.85 ± 21.25 g/L. All cases underwent gastroenteroscopy before TAE. Ten cases (71.43%) had duodenal bulb ulcers, 3 cases (21.43%) had duodenal ulcers, and 1 case (7.14%) had multiple ulcers in the gastric antrum. Bleeding was visible on endoscopy in 6 cases (Forrest Classification Ib,42.86%) (Table 2; Fig. 2), which were treated. All cases underwent TAE, and the timing of TAE averaged 4.29 ± 4.53 days. The responsible vessel was identified intraoperatively in all cases: gastroduodenal artery in 7 cases (50%) and pancreaticoduodenal artery in 7 cases (50%). A pseudoaneurysm was found in 2 cases (14.29%). Embolization of the responsible vessel was performed in all cases, using platinum coils alone in 8 cases (57.14%) and platinum coils combined with gelatin sponge in 6 cases (42.8%). All cases were followed up for an average of 13.69 ± 8.77 months, and no recurrence was detected.

Conclusion: TAE represents a promising intervention for pediatric patients with acute NVUGIB. Nevertheless, optimal timing, embolization techniques, and selection of embolizing agents necessitate further comprehensive investigation.

Keywords: Acute hemorrhage; Endoscopic; Nonvariceal upper Gastrointestinal bleeding; Pediatrics; Transcatheter arterial embolization.

Fig. 1

Transcatheter Arterial Embolization Process. (1A, 1B) Extravasation of contrast agent in the middle of the pancreaticoduodenal artery; (1C) The microcatheter was selected to distal end of the hemorrhagic port.; (1D, 1E) Two 2*5 mm platinum coils were placed at distal end of the hemorrhagic port.; (1F) At the proximal end of the hemorrhagic port, a 3*60 mm platinum coils was placed; 1G, (1H) No contrast agent spillage was found in the pancreatoduodenal artery during re-examination

Fig. 2

Gastroscopy showed pulsatile hemorrhage in the descending part of the duodenal bulb Yellow arrow: Pulsatile hemorrhage observed under gastroscopy