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Pyeong Hwa Kim Jiaywei Tsauo Ji Hoon Shin Sung-Cheol Yun 《Journal of vascular and interventional radiology : JVIR》2017,28(4):522-531.e5
Purpose
To evaluate the safety and efficacy of transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA) for the treatment of gastrointestinal (GI) bleeding via a meta-analysis of published studies.Materials and Methods
The MEDLINE/PubMed and EMBASE databases were searched for English-language studies from January 1990 to March 2016 that included patients with nonvariceal GI bleeding treated with transcatheter arterial embolization with NBCA with or without other embolic agents. The exclusion criteria were a sample size of < 5, no extractable data, or data included in subsequent articles or duplicate reports.Results
The cases of 440 patients (mean age, 63.8 y ± 14.3; 319 men [72.5%] and 121 women [27.5%]) from 15 studies were evaluated. Of these patients, 261 (59.3%) had upper GI bleeding (UGIB) and 179 (40.7%) had lower GI bleeding (LGIB). Technical success was achieved in 99.2% of patients with UGIB (259 of 261) and 97.8% of those with LGIB (175 of 179). The pooled clinical success and major complication rates in the 259 patients with UGIB in whom technical success was achieved were 82.1% (95% confidence interval [CI], 73.0%–88.6%; P = 0.058; I2 = 42.7%) and 5.4% (95% CI, 2.8%–10.0%; P = 0.427; I2 = 0.0%), respectively, and those in the 175 patients with LGIB in whom technical success was achieved were 86.1% (95% CI, 79.9%–90.6%; P = 0.454; I2 = 0.0%) and 6.1% (95% CI, 3.1%–11.6%; P = 0.382; I2 = 4.4%), respectively.Conclusions
Transcatheter arterial embolization with NBCA is safe and effective for the treatment of GI bleeding. 相似文献3.
《Journal of vascular and interventional radiology : JVIR》2014,25(1):10-19
PurposeTo assess the safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding (LGIB) and to determine the prognostic factors that affect clinical outcome.Materials and MethodsAll patients diagnosed with LGIB by angiography at a single institution from April 2006 to January 2013 were included in a retrospective study. The rates of technical success, early recurrent bleeding, major complications, clinical success, and in-hospital mortality for transcatheter arterial embolization were determined. The influence of possible prognostic factors on the outcome was analyzed.ResultsA total of 112 patients were included (36 with small-bowel LGIB, 36 with colon LGIB, and 40 with rectal LGIB). N-butyl cyanoacrylate (NBCA) was the embolic agent for 84 patients (75.0%), whereas gelatin sponge pledgets (n = 20), microcoils (n = 2), polyvinyl alcohol particles with adjunctive gelatin sponge pledgets (n = 1), and blood clots (n = 1) were used in the other patients. The technical success rate was 96.4%. For the entire group, the rates of early recurrent bleeding, major complications, clinical success, and in-hospital mortality were 17.4%, 4.6%, 74.5%, and 25.0%, respectively. These were 15.2%, 4.8%, 75.3%, and 26.2%, respectively, in the NBCA group. Hematologic malignancy, immobilization status, and coagulopathy were significant prognostic factors for clinical outcomes.ConclusionsTranscatheter arterial embolization is a safe and effective treatment for LGIB. NBCA could be used as a primary embolic agent for this procedure. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2014,25(6):839-846
PurposeTo evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene–vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, California) as the primary treatment for acute and massive lower gastrointestinal bleeding (LGIB).Materials and MethodsBetween January 2008 and October 2013, all patients with focal massive LGIB who were treated by embolization were retrospectively analyzed. The study was approved by the hospital’s ethics committee; informed consent was obtained in all cases. Onyx was chosen as the embolic agent in all cases in an intention-to-treat fashion. Embolization was indicated in 31 consecutive patients (mean age, 80 y ± 11.1). Multidetector computed tomography and digital subtraction angiography were performed in all patients.ResultsActive bleeding was detected in all cases. A colonoscopy was performed in 11 patients. The correlation between multidetector computed tomography and angiography findings was 96.7%. The causes of bleeding were diverticula in 15 patients, iatrogenic in 7 patients, neoplasia in 3 patients, hemorrhoids in 2 patients, angiodysplasia in 2 patients, and unknown in 2 patients. Embolization was not possible in one patient, who required urgent left hemicolectomy. The technical success rate was 93.5%. The embolic material refluxed in one patient, causing an undesired embolization, without any clinical consequences. In the 30 patients who received embolization, the immediate bleeding control rate was 100%. Rebleeding at 30 days occurred in three patients (10%). There were no major complications, intestinal ischemia, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 23.7 months (range, 1–71 mo).ConclusionsControl of massive LGIB using superselective embolization with Onyx is feasible and safe. 相似文献
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《Mayo Clinic proceedings. Mayo Clinic》2017,92(5):797-804
The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner. 相似文献
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Nassir Alhaboob Arabi Abdulmagid Mohammed Musaad Fatima Abbas Habiballah Mohammed Elsaggad Eltayeb Ahmed Muataz Salah Eldin Abdelaziz 《Arab Journal Of Gastroenterology》2018,19(2):84-87
Background and study aims
Lower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronic bleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients.Patients and methods
In a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study. All patients with fresh rectal bleeding within 24?h were included and consented.Result
Lower gastrointestinal bleeding constituted 5.37% of total cases of gastrointestinal bleeding. The mean age of patients was 55.43?±?17.779, male: female ratio was 2:1. The most common cause (if upper gastrointestinal bleeding is excluded) was diverticular disease 39.6% (n?=?61) followed by piles 24.1% (n?=?35), colonic tumours 12.34% (n?=?19), ulcerative colitis 5.19% (n?=?8), Crohn’s 5.19% (n?=?8), colonic polyps 3,89% (n?=?6), angiodysplesia 4.5% (n?=?7), colonic ulcer 2.59% (n?=?4), ischaemic colitis 1.3%, nonspecific colitis 1.3% (n?=?2), and small bowel source in 1.3% (n?=?2). The majority of those patients with diverticular disease were male and with first presentation. The commonest cause in those patients younger than 20?years was polyps, and in those between 21 and 40 was piles followed by inflammatory bowel disease, and in those between 41 and 60?years old was piles followed by diverticular disease and tumours, and in those above 60?years was diverticular disease followed by piles and tumours. The correlation between positive colonoscopy finding and diabetes and the use of nonsteroidal anti-inflammatory drugs were statistically significant. The one-month mortality rate was 2.3%Conclusion
Acute lower gastrointestinal bleeding is common among elderly patients and the commonest cause is diverticular disease. Colonoscopy plays an important role in the diagnosis. Most patients respond to conservative therapy. 相似文献7.
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