title: Is there a role for empiric gastroduodenal artery embolization in the management of patients with active upper GI hemorrhage?
abstract: OBJECTIVE
  To assess the relative efficacy of empiric gastroduodenal artery (GDA) embolization in reducing recurrent hemorrhage compared to image-guided targeted embolization.
  
  
  METHODS
  Data were retrospectively collected for consecutive patients who had catheter angiography for major upper gastrointestinal hemorrhage from May 2008 to November 2010 (n = 40). The total number of cases were divided into two main groups according to angiographic findings: those that demonstrated a site of hemorrhage on catheter angiography (group 1, n = 13), and those where the site of hemorrhage was not identified on catheter angiography (group 2, n = 27). Group 2 was then further divided into patients who received empiric embolization (group 2a, n = 20) and those who had no embolization performed after angiography (group 2b, n = 7).
  
  
  RESULTS
  The technical and clinical success rates for embolization in groups 1 and 2a were, respectively, 100 vs. 95%, and 85 vs. 80%. There was no statistical significance in the recurrent hemorrhage rate, reintervention rate, or 30 day mortality between targeted and empiric embolization groups. There were no complications attributed to embolization within this study cohort.
  
  
  CONCLUSIONS
  Cases of duodenal-related major upper gastrointestinal hemorrhage where no embolization is performed have poor outcome. Empiric embolization of the GDA in patients with major upper gastrointestinal hemorrhage refractory to endoscopic treatment appears to be a safe and effective treatment, with low reintervention rates and good clinical outcome comparable to patients where the site of hemorrhage is localized and embolized with computed tomographic angiography or catheter angiography and embolized.
authors.affiliation: Department of Radiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. shaheen7noorani@gmail.com
authors.forename: Shaheen
authors.initials: S
authors.lastname: Dixon
authors.forename: Victoria
authors.initials: V
authors.lastname: Chan
authors.forename: Vivek
authors.initials: V
authors.lastname: Shrivastava
authors.forename: Susan
authors.initials: S
authors.lastname: Anthony
authors.forename: Raman
authors.initials: R
authors.lastname: Uberoi
authors.forename: Mark
authors.initials: M
authors.lastname: Bratby
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000494:pharmacology; D011322:Primary Prevention / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013270:Stomach / Q000098:blood supply*; D015996:Survival Rate; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000098:blood supply* / Q000000981:diagnostic imaging
chemical_list: D011142:Polyvinyl Alcohol