Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups.
10.3348/kjr.2011.12.5.568
- Author:
Wei Chou CHANG
1
;
Chang Hsien LIU
;
Hsian He HSU
;
Guo Shu HUANG
;
Ho Jui TUNG
;
Tsai Yuan HSIEH
;
Shih Hung TSAI
;
Chung Bao HSIEH
;
Chih Yung YU
Author Information
1. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. chougo2002@yahoo.com.tw
- Publication Type:Original Article ; Comparative Study ; Research Support, Non-U.S. Gov't
- Keywords:
Acute massive gastrointestinal bleeding;
Angiography;
Contrast extravasation;
Coil embolization;
Vasopressin
- MeSH:
Acute Disease;
Adult;
Aged;
Aged, 80 and over;
*Angiography;
*Embolization, Therapeutic;
Extravasation of Diagnostic and Therapeutic Materials/*radiography;
Female;
Gastrointestinal Hemorrhage/mortality/radiography/*therapy;
Hemostasis, Endoscopic;
Hemostatics/*administration & dosage;
Humans;
Infusions, Intra-Arterial;
Male;
Middle Aged;
*Radiography, Interventional;
Treatment Failure;
Vasopressins/*administration & dosage;
Young Adult
- From:Korean Journal of Radiology
2011;12(5):568-578
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. MATERIALS AND 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. CONCLUSION: Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.
