Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups

  • Chang, Wei-Chou (Department of Radiology, Tri-Service General Hospital, National Defense Medical Center) ;
  • Liu, Chang-Hsien (Department of Radiology, Tri-Service General Hospital, National Defense Medical Center) ;
  • Hsu, Hsian-He (Department of Radiology, Tri-Service General Hospital, National Defense Medical Center) ;
  • Huang, Guo-Shu (Department of Radiology, Tri-Service General Hospital, National Defense Medical Center) ;
  • Tung, Ho-Jui (Department of Healthcare Administration, Asia University) ;
  • Hsieh, Tsai-Yuan (Department of Internal Medicine, Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center) ;
  • Tsai, Shih-Hung (Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center) ;
  • Hsieh, Chung-Bao (Department of Surgery, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center) ;
  • Yu, Chih-Yung (Department of Radiology, Tri-Service General Hospital, National Defense Medical Center)
  • Published : 2011.10.01
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Abstract

Objective: To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. Materials and Methods: From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates. Results: Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemostasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients. Conclusion: Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

Keywords

References

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