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Clinical Outcomes of Transcatheter Arterial Embolization after Failed Endoscopic Intervention for Acute Non-Variceal Bleeding Associated with Benign Upper Gastrointestinal Diseases

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Author(s)
Sang Yoon KimSu Jin KimAyoung LeeKichul YoonJun Young ParkJu Yup LeeJae Myung Park
Keimyung Author(s)
Lee, Ju Yup
Department
Dept. of Internal Medicine (내과학)
Journal Title
Korean J Helicobacter Up Gastrointest Res
Issued Date
2023
Volume
23
Issue
1
Keyword
AngiographyEndoscopyEmbolizationMortality
Abstract
Background/Aims:
Transcatheter arterial embolization (TAE) is useful for management of uncontrolled upper gastrointestinal (UGI) bleeding. We investigated clinical outcomes of TAE for non-variceal bleeding from benign UGI diseases uncontrolled with endoscopic intervention.

Methods:
This retrospective study performed between 2017 and 2021 across four South Korean hospitals. Ninety-two patients (72 men, 20 women) who underwent angiography were included after the failure of endoscopic intervention for benign UGI disease- induced acute non-variceal bleeding. We investigated the factors associated with endoscopic hemostasis failure, the technical success rate of TAE, and post-TAE 30-day rebleeding and mortality rates.

Results:
The stomach (52/92, 56.5%) and duodenum (40/92, 43.5%) were the most common sites of bleeding. Failure of endoscopic procedures was attributable to peptic ulcer disease (81/92, 88.0%), followed by pseudo-aneurysm (5/92, 5.4%), and angiodysplasia (2/92, 2.2%). Massive bleeding that interfered with optimal visualization of the endoscopic field was the most common indication for TAE both in the stomach (22/52, 42.3%) and duodenum (14/40, 35.0%). Targeted TAE, empirical TAE, and exclusive arteriography were performed in 77 (83.7%), nine (9.8%), and six patients (6.5%), respectively. The technical success rate, the post-TAE 30-day rebleeding rate, and the overall mortality rate were 100%, 22.1%, and 5.8%, respectively. On multivariate analysis, coagulopathy (OR, 5.66; 95% CI, 1.71~18.74; P=0.005) and empirical embolization (OR, 5.71; 95% CI, 1.14~28.65; P=0.034) were independent risk factors for post-TAE 30-day rebleeding episodes.

Conclusions:
TAE may be useful for acute non-variceal UGI bleeding. Targeted embolization and correction of coagulopathy can improve clinical outcomes.
Keimyung Author(s)(Kor)
이주엽
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2671-826X
Source
https://www.helicojournal.org/journal/view.php?doi=10.7704/kjhugr.2022.0054
DOI
10.7704/kjhugr.2022.0054
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44805
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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