title: Management of angiogram-negative acute colonic hemorrhage: safety and efficacy of colonoscopy-guided superselective embolization.
abstract: BACKGROUND
  We evaluated the efficacy and safety of superselective embolization with assistance of colonoscopy for acute colonic hemorrhage.
  
  
  METHODS
  Of 92 cases of acute colonic hemorrhage requiring colonoscopic intervention, 11 (12 %) could not be successfully treated. Of these, 10 patients (9 men, mean age 65.5 years, range 39-75 years) underwent superselective embolization. Hemorrhage was caused by diverticular disease (n = 8), polypectomy (n = 1), and vascular malformation (n = 1). In all 10 cases, the radiopaque clips were placed at the bleeding point via colonoscopy. Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta leading to or near the clips with Gelfoam particles, microcoils, or both.
  
  
  RESULTS
  Immediate hemostasis was achieved in all patients. In 6 of 10 patients (60 %), selective angiograms showed no active extravasation at the time of the procedure and the embolization was performed using clips as a landmark. In the remaining four patients, selective angiograms showed active extravasation from the vasa recta leading to the clips. The mean number of embolized vessels with no active extravasation and with active extravasation was 1.83 (range 1-3) and 1.25 (range 1-2), respectively. The mean duration of clinical follow-up was 11.6 months (range 1-29 months). One patient (10 %) bled from a different site than the treated site a month after embolization, but the bleeding ceased after endoscopic intervention. All the patients (100 %) were evaluated for objective evidence of ischemia by colonoscopy. Four of the 10 patients (40 %) were found endoscopically to have small areas of ischemia involving only the mucosa, but they remained asymptomatic. There was no bowel infarction or stricture.
  
  
  CONCLUSIONS
  Colonoscopy-assisted superselective embolization may be a safe and useful procedure for acute colonic hemorrhage without active extravasation on angiogram.
authors: Department of Radiology, Ryukyu University of Medicine, Okinawa, Japan, jana@mx51.et.tiki.ne.jp.
authors: J
authors: J
authors: Heianna
authors: T
authors: T
authors: Miyauchi
authors: H
authors: H
authors: Yamano
authors: K
authors: K
authors: Yoshikawa
authors: M
authors: M
authors: Hashimoto
authors: S
authors: S
authors: Murayama
mesh_terms: D000208:Acute Disease; D000328:Adult; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003113:Colonoscopy / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome