title: Intra-arterial treatment in patients with acute massive gastrointestinal bleeding after endoscopic failure: comparisons between positive versus negative contrast extravasation groups.
abstract: OBJECTIVE
  To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure.
  
  
  METHODS
  From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates.
  
  
  RESULTS
  Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemostasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients.
  
  
  CONCLUSIONS
  Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Liu
authors.forename: Hsian-He
authors.initials: HH
authors.lastname: Hsu
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
authors.forename: Ho-Jui
authors.initials: HJ
authors.lastname: Tung
authors.forename: Tsai-Yuan
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Yu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D017211:Treatment Failure; D014667:Vasopressins / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D006490:Hemostatics; D014667:Vasopressins