What is the efficacy of superselective embolization in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Kuo et al concluded the superselective microcoil embolization for the treatment of LGIB is safe and effective. [65] They reported complete clinical success in 86% of patients, with a rebleeding rate of 14%. Minor ischemic complication rates were 4.5%, and )% major ischemic complication rates were reported. The investigators also reviewed the data from 122 cases of lower gastrointestinal (GI) superselective microcoil embolization in the literature, with meta-analysis performed in 144 patients. The combined analysis revealed a minor ischemic complication rate of 9% and a major ischemic complication rate of 0%. [65]

Rossetti at al reviewed 11 years of experience in transarterial embolization of acute colonic bleeding in 24 Swiss patients and found the risk of bowel ischemia was 21%. [66] The patients underwent colonic embolization for diverticular disease, postpolypectomy, and bleeding, as well as bleeding from cancer, angiodysplasia, and hemorrhoids. All the different types of bleeding stopped except hemorrhoidal bleeding, requiring hemorrhoidal ligature. [66] In separate study, 44 patients underwent microcoil embolization for arterial GI bleeding, with a technical success rate of 88% but a clinical success rate of 57%. [67] Intestinal ischemia occurred in 5% of patients. Overall mortality was 18%. The investigators concluded that microcoil embolization had a high success rate, and the number of preprocedural and postprocedural transfusions did not affect the technical success. [67]

In another study by Yap et al, 95 patients underwent embolization for acute GI hemorrhage, with immediate hemostasis obtained in 98% of patients. [68] Eighty percent of the patients had upper GI hemorrhage and the rest had lower GI hemorrhage. Vessels embolized included gastroduodenal (39%), pancreatoduodenal (20%), gastric (19%), superior mesenteric (11%), inferior mesenteric (11%), and splenic artery (4%). Complications included bowel ischemia in 4% and coil migration in 3% of patients. The overall 30-day mortality rate was 18%. [68]

Therapeutic upper (n=16) and lower GI (n=23) embolization was performed on 39 occasions in 37 Japanese patients using N-butyl-2-cyanoacrylate (1:1 and in 1:5 mixtures). [69] Recurrent bleeding occurred in two patients, hepatic abscess in two cases, and lower limb ischemia in one patient. No intestinal necrosis occurred. It was concluded that transcatheter arterial embolization was safe and effective with a high rate of complete hemostasis. [69]

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