Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding.

Abstract : BACKGROUND AND AIMS:: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been proposed but factors that influence the angiographic outcome are not well documented. We aimed to identify predictors of recurrent bleeding within 30 days after transcatheter embolization for refractory hemorrhage from gastroduodenal ulcers. METHODS:: This retrospective single-center study of 60 consecutive emergency embolization procedures included hemodynamically unstable patients (41 males, 19 females, mean age 69.4+/-15 years), referred from 1999 to 2008 for selective angiography after failed endoscopic treatment. Predictors of early rebleeding were tested with univariate analysis and a multivariate logistic regression model. RESULTS:: The procedural success rate was 95%, the primary clinical success rate was 71.9% (41/57), and secondary clinical success was achieved in 3 patients (77.2%) after repeat embolization. No major catheterization-related complications occurred. Periprocedural mortality was 26.7% (16/60). Early bleeding recurrence was associated with coagulation disorders ( P =0.007), longer time to angiography ( P =0.0005), greater preprocedural blood transfusion volume ( P =0.0009), =2 comorbidities ( P =0.005), and use of only coils ( P =0.003). Two factors were independent predictors of embolization failure: coagulation disorders (odds ratio[OR]=6.18; P =0.027) and the use of coils as the only embolic agent (OR=6.24; P =0.022). The median follow-up time was 7 months (range of 1 day to 103 months). CONCLUSIONS:: Angiographic embolization should be performed early in the course of bleeding, and not with coils alone, in critically ill patients. It is important to correct coagulation disorders throughout the embolization procedure.
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Clinical Gastroenterology and Hepatology, WB Saunders, 2009, epub ahead of print. 〈10.1016/j.cgh.2009.02.003〉
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Contributeur : Pablo Ortega Deballon <>
Soumis le : mercredi 21 avril 2010 - 11:40:36
Dernière modification le : dimanche 11 février 2018 - 01:14:24

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Romaric Loffroy, Boris Guiu, Philippe D'Athis, Lise Mezzetta, Alice Gagnaire, et al.. Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding.. Clinical Gastroenterology and Hepatology, WB Saunders, 2009, epub ahead of print. 〈10.1016/j.cgh.2009.02.003〉. 〈inserm-00475165〉

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