Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience

PURPOSEThe study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding.METHODSNine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed.RESULTSThe angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE.CONCLUSIONTAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.

Acute arterial esophageal bleeding is a major cause of morbidity and mortality (1, 2). Peptic ulcer disease, Mallory-Weiss syndrome, esophagitis, and malignancy are the most common etiologies.Upper gastrointestinal (GI) endoscopy is the gold standard for the diagnosis and treatment of upper GI bleeding (1, 3). However, as technology advances, transcatheter arterial embolization (TAE) with gelatin sponge particles, coils, and liquid embolic materials is increasingly used as an alternative to surgery to treat GI bleeding which is refractory to endoscopic management (4–7).TAE was first reported in 1972 as an alternative to the surgical management of GI bleeding in case of endoscopic treatment failure (8). Since then, there have been constant innovations in the embolic agents used in endovascular therapy for GI bleeding. The purpose of this study was to evaluate the safety and clinical efficacy of TAE for the treatment of arterial esophageal bleeding.