Superselective Embolization for Arterial Upper Gastrointestinal Bleeding Using N-Butyl Cyanoacrylate: A Single-Center Experience in 152 Patients

• Published in: Journal of vascular and interventional radiology Vol. 28; no. 12; pp. 1673 - 1680
• Main Authors: Hur, Saebeom, Jae, Hwan Jun, Lee, Hyukjoon, Lee, Myungsu, Kim, Hyo-Cheol, Chung, Jin Wook
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Aged; Angiography; Contrast Media; Embolization, Therapeutic - methods; Enbucrilate - therapeutic use; Female; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Gastroscopy; Humans; Male; Middle Aged; Postoperative Complications - epidemiology; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; UGIB; NBCA; OR
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2017.07.027

To evaluate 30-day safety and efficacy of superselective embolization for arterial upper gastrointestinal bleeding (UGIB) using N-butyl cyanoacrylate (NBCA). This single-center retrospective 10-year study included 152 consecutive patients with UGIB (gastric, n = 74; duodenal, n = 78) who underwent embolization with NBCA for angiographically positive arterial bleeding. The primary endpoint was clinical success rate defined as achievement of hemostasis without rebleeding or UGIB-related mortality within 30 days after embolization. Mean systolic blood pressure and heart rate were 121.2 mm Hg ± 27.4 and 97.9 beats/minute ± 22.5; 31.1% of patients needed intravenous inotropes, and 36.6% had coagulopathy. The etiology of bleeding was ulcer (80.3%) or iatrogenic injury (19.7%). Statistical analysis was performed to identify predictive factors for outcomes. Technical success rate was 100%. Clinical success, 1-month mortality, and major complication rates were 70.4%, 22.4%, and 0.7%. There were significant differences in the clinical success rates between gastric and duodenal bleeding (79.4% vs 62.2%; P = .025). The need for intravenous inotropes at the time of embolization was a significant negative predictive factor in both gastric (odds ratio [OR] = 0.091, P = .004) and duodenal (OR = 0.156, P = .002) bleeding. The use of a microcatheter with a smaller tip (2 F) was associated with better outcomes in duodenal bleeding (OR = 7.389, P = .005). Superselective embolization using NBCA is safe and effective for angiographically positive arterial UGIB.