The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

다국어 초록 (Multilingual Abstract)

Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography.
Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates.
Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications.
Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure.
Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

다국어 초록 (Multilingual Abstract)

Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography.
Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates.
Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications.
Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure.
Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

참고문헌 (Reference)

1 Johnston C, "Use of provocative angiography to localize site in recurrent gastrointestinal bleeding" 30 : 1042-1046, 2007

2 Darcy M, "Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization" 14 : 535-543, 2003

3 Charbonnet P, "Treatment of gastrointestinal hemorrhage" 30 : 719-726, 2005

4 Hwan Jun Jae, "Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate" 대한영상의학회 8 (8): 48-56, 2007

5 Angtuaco TL, "The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center" 96 : 1782-1785, 2001

6 Billingham RP, "The conundrum of lower gastrointestinal bleeding" 77 : 241-252, 1997

7 Bandi R, "Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage" 12 : 1399-1405, 2001

8 Setya V, "Subtotal colectomy as a last resort for unrelenting unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases" 58 : 295-299, 1992

9 Gordon RL, "Selective arterial embolization for the control of lower gastrointestinal bleeding" 174 : 24-28, 1997

10 Drooz AT, "Quality improvement guidelines for percutaneous transcatheter embolization: SCVIR Standards of Practice Committee. Society of Cardiovascular and Interventional Radiology" 8 : 889-895, 1997

11 Peck DJ, "Percutaneous embolotherapy of lower gastrointestinal hemorrhage" 9 : 747-751, 1998

12 Ryan JM, "Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, tolazoline" 12 : 1273-1277, 2001

13 Diehl SJ, "Negative endoscopy and MSCT findings in patients with acute lower gastrointestinal hemorrhage. Value of (99m) Tc erythrocyte scintigraphy" 47 : 64-70, 2007

14 d’Othee BJ, "Microcoil embolization for acute lower gastrointestinal bleeding" 29 : 49-58, 2006

15 Burgess AN, "Lower gastrointestinal haemorrhage and superselective angiographic embolization" 74 : 635-638, 2004

16 Kusano S, "Lowdose particulate polyvinyl alcohol embolization in massive small artery intestinal hemorrhage. Experimental and clinical results" 22 : 388-392, 1987

17 Rockall TA, "Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage" 311 : 222-226, 1995

18 Luchtefeld MA, "Evaluation of transarterial embolization for lower gastrointestinal bleeding" 43 : 532-534, 2000

19 Longstreth GF, "Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population- based study" 92 : 419-424, 1997

20 Han YM, "Embolization of superior mesenteric artery branches in dogs. Ischemic bowel changes depend on location of vessel occlusion and embolic materials" 34 : 629-635, 1999

21 Waugh J, "Embolization for major lower gastrointestinal haemorrhage: five-year experience" 48 : 311-317, 2004

22 Defreyne L, "Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage" 218 : 739-748, 2001

23 Gupta S, "Detection of gastrointestinal bleeding by radionuclide scintigraphy" 79 : 26-31, 1984

24 Kuhle WG, "Detection of active colonic hemorrhage with use of helical CT: findings in a swine model" 228 : 743-752, 2003

25 Yoon W, "Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT" 239 : 160-167, 2006

26 Zuckerman GR, "Acute lower intestinal bleeding: part II. Etiology, therapy, and outcomes" 49 : 228-238, 1999

27 Zuckerman GR, "Acute lower intestinal bleeding: part I. Clinical presentation and diagnosis" 48 : 606-617, 1998