Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3728
Peer-review started: September 8, 2019
First decision: October 24, 2019
Revised: November 14, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: November 26, 2019
Processing time: 79 Days and 2.9 Hours
Acute gastrointestinal (GI) bleeding is an emergency condition that can lead to significant morbidity and mortality. Embolization is considered the preferred therapy in the treatment of lower GI bleeding when it is unrealistic to perform the surgery or vasopressin infusion in this population. Treatment of acute lower GI bleeding (any site below the ligament of Treitz) using this technique has not reached a consensus because of the belief that the risk of intestinal infarction in this condition is extremely high. The purpose of the study is to evaluate the effectiveness and safety of this technique in a retrospective group of patients who underwent embolization for acute lower GI bleeding.
Because of a relative deficiency of collateral blood supply, transcatheter embolization is a challenging procedure with a significant risk of bowel ischemia.
To evaluate the efficacy and safety of super-selective arterial embolization in the management of acute lower GI bleeding.
This study is a retrospective review of patients who underwent super-selective arterial embolization for acute lower GI bleeding. After embolization, they were monitored for postoperative bleeding and signs of intestinal infarction. Several outcomes were analyzed, including rate of initial technical success, rebleeding rate within 7 d after embolization, and complication rate.
The bleeding was more likely to happen in the proximal colon, and the outcome showed that the majority cases of hemorrhage were located in the right colon. Embolization therapy resulted in successful hemostasis in all 26 patients (100%) in whom embolization was possible. Rebleeding at less than 7 d after embolization occurred only in 1 patient (3.8%). Rebleeding occurred at 1 d after embolization in this patient who went to the operating room for resection. No complication was recorded during the embolization and during the post-procedure period, and no ischemic complication occurred.
Super-selective arterial embolization for acute lower GI hemorrhage is effective and safe. This procedure should be the initial treatment in patients who suffer severe bleeding that requires angiography and have indication for super-selective catheterization. With super-selective embolization, the risk of symptomatic bowel ischemia can be minimalized.
To avoid bowel infarction after embolization, careful technique and preparation for turning down the embolization are pivotal, particularly when a suitable catheter position cannot be achieved. In addition, it is also important to choose a suitable embolic agent.