Angiographic embolization for gastroduodenal hemorrhage can be achieved technically in most patients, but in-hospital rebleeding occurs in almost half of cases, researchers report in the May issue of the Archives of Surgery.
Dr. Paul V. Vignati of Hartford Hospital, Connecticut and colleagues conducted a retrospective study of 70 embolization procedures carried out over a 10-year period in 57 patients who had been referred following endoscopic treatment failure. The patients were not immediate candidates for surgery.
Target vessel devascularization was achieved in 66/70 angiographies (94%), and primary cessation of bleeding was achieved in 29/57 patients (51%). After repeat embolization, clinical success was achieved in 32 patients (56%).
Mortality was 36% (9/25) in patients in whom embolization failed and 9% (3/32) in patients in whom embolization was successful.
The team found that recent duodenal ulcer suture ligation and blood transfusion of more than 6 units before the procedure were independent predictors of poor outcome.
“Our study,” Dr. Vignati pointed out in remarks to Reuters Health, “shows that angiographic embolization may be a viable option in poor surgical candidates; however, there is a 50% risk of re-hemorrhage. Surgical control of upper GI bleeding remains the mainstay of treatment.”
Nevertheless, Dr. Michael E. Zenilman of SUNY Downstate Medical Center, Brooklyn, New York, the author of an accompanying editorial, commented: “Overall, I think this article is a great example of the modern, multidisciplinary approach to complicated medical problems. Acute gastrointestinal bleeding was once exclusively a ‘surgical disease’, but now it needs to be cared for by a team of professionals.”
Reviewed by Ramaz Mitaishvili, MD
