title: Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy.
abstract: OBJECTIVE
  To report short-term results of empiric transcatheter embolization for patients with advanced malignancy and gastrointestinal (GI) hemorrhage directly from a tumor invading the GI tract wall.
  
  
  METHODS
  Between 2005 and 2011, 37 mesenteric angiograms were obtained in 26 patients with advanced malignancy (20 men, six women; mean age, 56.2 y) with endoscopically confirmed symptomatic GI hemorrhage from a tumor invading the GI tract wall. Angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as absence of signs and symptoms of hemorrhage for at least 30 day following embolization.
  
  
  RESULTS
  Active extravasation was demonstrated in three cases. Angiographic abnormalities related to a GI tract tumor were identified on 35 of 37 angiograms, including tumor neovascularity (n = 21), tumor enhancement (n = 24), and luminal irregularity (n = 5). In the absence of active extravasation, empiric embolization with particles and/or coils was performed in 25 procedures. Cessation of hemorrhage (ie, clinical success) occurred more frequently when empiric embolization was performed (17 of 25 procedures; 68%) than when embolization was not performed (two of nine; 22%; P = .03). Empiric embolization resulted in clinical success in 10 of 11 patients with acute GI bleeding (91%), compared with seven of 14 patients (50%) with chronic GI bleeding (P = .04). No ischemic complications were encountered.
  
  
  CONCLUSIONS
  In patients with advanced malignancy, in the absence of active extravasation, empiric transcatheter arterial embolization for treatment of GI hemorrhage from a direct tumor source demonstrated a 68% short-term success rate, without any ischemic complications.
authors.affiliation: Divisions of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tandberg
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.forename: Paul V
authors.initials: PV
authors.lastname: Suhocki
authors.forename: Waleska
authors.initials: W
authors.lastname: Pabon-Ramos
authors.forename: Rendon C
authors.initials: RC
authors.lastname: Nelson
authors.forename: Svetang
authors.initials: S
authors.lastname: Desai
authors.forename: Stanley
authors.initials: S
authors.lastname: Branch
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D005770:Gastrointestinal Neoplasms / Q000098:blood supply / Q000150:complications* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000098:blood supply* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome