| Institution: | 1. Penn Image-Guided Interventions Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Radiology, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania;4. Department of Cancer Biology, Perelman School of Medicine, Philadelphia, Pennsylvania;1. Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People’s Republic of China;2. Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China;1. Department of Interventional Radiology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa, Japan;2. Department of Cardiovascular Surgery, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa, Japan;1. Department of Vascular and Interventional Radiology, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina;1. Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;2. Division of Hematology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, California;3. Division of Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California;4. Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts |
| Abstract: | PurposeTo evaluate gastric and intestinal mucosal changes on postembolic endoscopy and mortality after transarterial embolization (TAE) for upper gastrointestinal bleeding (UGIB).Materials and MethodsAn institutional review board–approved retrospective review of patients who underwent arteriography for refractory UGIB at a multicenter health system from December 2003 to August 2019 was performed. Two hundred sixty-nine patients underwent TAE for UGIB. Data on etiology of bleeding, embolization technique, pre-embolic and postembolic endoscopic results, blood product requirements, and mortality were collected from the medical record. Endoscopy results were compared at the site of the target lesion before and after TAE. Multivariable logistic regressions were performed to assess predictors of new adverse mucosal responses and mortality.ResultsThe most common etiology of UGIB was peptic ulcer. Twenty-five percent (n = 68) of the patients had clinical evidence of rebleeding after TAE, and the 30-day mortality rate was 26% (n = 73). Eighty-eight (32%) patients underwent post-TAE endoscopy, with only 15% showing new adverse mucosal changes after embolization. Procedural characteristics, including vascular territory and embolic choice, were not significantly predictive of increased risk of development of adverse mucosal response after TAE or increased mortality risk. No patients in the study were found to have bowel lumen stenosis at the time of post-TAE endoscopy or at 6 year follow-up.ConclusionsTAE is a safe and effective intervention for patients with UGIB. Post-TAE endoscopy demonstrated that most patients had either stability or improvement in the target lesion after TAE, and only a minority of patients demonstrated adverse mucosal changes. |
