David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

The technical success of therapeutic and prophylactic embolization does not translate to clinical success for many patients.

Patients with acute nonvariceal upper gastrointestinal bleeding (UGIB) who fail endoscopic and pharmacologic therapy may be referred for radiographic therapy (RT), including embolization. To determine outcomes of RT in this setting, investigators retrospectively reviewed data on 74 adults (mean age, 60) who presented with acute UGIB and underwent catheter angiography. Of these, 34 were found to have active bleeding and 40 to have no active bleeding.

A total of 31 of 33 eligible patients with active bleeding underwent technically successful therapeutic embolization. Of 40 without active bleeding, 22 received no embolotherapy, and the remaining 18 patients underwent technically successful prophylactic embolization.

The 30-day clinical success rate was similar in patients treated with therapeutic or prophylactic embolization (68% and 67%, respectively). Long-term clinical success rates were 58% (mean, 15.7 months) for therapeutic embolization, 67% (mean, 13.8 months) for prophylactic therapy, and 61.2% (mean 15.2 months) for untreated patients. Overall 30-day mortality was 23%. No major procedure-related complications occurred. Untreated patients without active bleeding had spontaneous cessation of bleeding and lower early rebleeding rates.

Citation(s):

Sildiroglu O et al. Outcomes of patients with acute upper gastrointestinal nonvariceal hemorrhage referred to interventional radiology for potential embolotherapy. J Clin Gastroenterol 2014 Sep; 48:687.