Will transcatheter embolotherapy replace surgery in the treatment of gastrointestinal bleeding?(2)(2).
Superselective angiography and transcatheter embolization (SATE) have produced mixed results in the treatment of upper gastrointestinal bleeding (UGIB). The use of SATE to treat hemorrhage distal to the ligament of Treitz has been approached with trepidation because of limited collateral blood supply to the gastrointestinal tract beyond the duodenum. Ischemic bowel injury rates of 15% to 35% are reported when SATE is used to treat lower gastrointestinal bleeding (LGIB). Recent improvements in coaxial catheter design and embolic agents and greater expertise of personnel performing interventional angiographic procedures have decreased the risks of SATE in the lower gastrointestinal tract. The purpose of this study is to review our experience with SATE in the management of both UGIB and LGIB. %METHODS:This is a retrospective cohort study of patients undergoing SATE between January 1996 and November 1998. All SATE was performed in an angiographic suite with the latest generation coaxial catheters and embolic agents. Patient characteristics and outcome measures were noted. Efficacy of SATE was determined by analyzing the following outcome measures: initial technical success, rebleeding rate at less than 30 days post-SATE, the total rebleeding rate post-SATE, the number of patients requiring surgery despite SATE, and the complication rate. Patients undergoing SATE for LGIB were clinically monitored for development of ischemic complications.Of 523 admissions for UGIB and LGIB, 35 patients (6.7%) underwent SATE as definitive therapy for control of gastrointestinal hemorrhage (25 UGIB and 10 LGIB). Mean age of treated patients was 67 years; 49% had greater than 3 significant systemic comorbidities. Initial control of bleeding was achieved in 23/25 UGIB and 10/10 LGIB patients. Rebleeding at less than 30 days occurred in 5/23 UGIB and 2/10 LGIB patients. Rebleeding at greater than 30 days occurred in 2 additional UGIB patients. No known duodenal stenosis or ischemic bowel injury occurred in patients undergoing SATE for UGIB or LGIB, respectively, during the follow-up period.SATE is an excellent therapeutic method for GI bleeding in selected patients, and definitive control is frequently afforded. In the remainder, SATE may allow temporary control and resuscitation of the unstable patient. SATE appears to be as safe and effective for LGIB as it is for UGIB. Further studies are needed to better define the role of SATE for GI bleeding.
Patel
T H.
TH
Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
Cordts
P R.
PR
Abcarian
P
P
Sawyer
M A.
MA