Mesenteric Embolization for Lower Gastrointestinal Bleeding

Mesenteric Embolization for Lower Gastrointestinal Bleeding

PURPOSE:Mesenteric embolization is an established treatment for lower gastrointestinal bleeding. The aim of this study was to determine the outcome of angiography and embolization and its influencing factors. METHODS:A prospective database of all mesenteric angiograms performed for lower gastrointes...

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Bibliographic Details
Published in:Diseases of the colon & rectum Vol. 53; no. 9; pp. 1258 - 1264
Main Authors: Gillespie, Chris J, Sutherland, Andrew D, Mossop, Peter J, Woods, Rodney J, Keck, Jamie O, Heriot, Alexander G
Format: Journal Article
Language:English
Published: Hagerstown, MDc The ASCRS 01-09-2010
Lippincott Williams & Wilkins
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Angiography
Biological and medical sciences
Chi-Square Distribution
Comorbidity
Embolization, Therapeutic - adverse effects
Embolization, Therapeutic - methods
Female
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal Hemorrhage - diagnostic imaging
Gastrointestinal Hemorrhage - mortality
Gastrointestinal Hemorrhage - therapy
Humans
Male
Medical sciences
Mesentery - blood supply
Middle Aged
Other diseases. Semiology
Prospective Studies
Recurrence
Retreatment
Risk Factors
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Treatment Outcome
Mesenteric angiogram
Mesenteric embolization
Gastrointestinal bleeding
Lower gastrointestinal bleeding
Gastroenterology
Instrumentation therapy
Digestive diseases
Intestinal disease
Embolization
Mesentery
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Summary:PURPOSE:Mesenteric embolization is an established treatment for lower gastrointestinal bleeding. The aim of this study was to determine the outcome of angiography and embolization and its influencing factors. METHODS:A prospective database of all mesenteric angiograms performed for lower gastrointestinal bleeding at a tertiary center between 1998 and 2008 was analyzed in combination with chart review. RESULTS:There were 107 angiograms performed during 83 episodes of lower gastrointestinal bleeding in 78 patients. Active bleeding was identified in 40 episodes (48%), and embolizations were performed in 37 (45%). One patient without active bleeding on angiogram also underwent embolization, making a total of 38 embolizations. Overall mortality was 7% with 4 deaths due to rebleeding and 2 deaths due to a medical comorbidity (respiratory failure, pneumonia). Short-term complications of angiography were false aneurysm (1 patient) and Enterobacter sepsis (1 patient). Long-term complications were groin lymphocele (1 patient) and late rebleed from collateralization (1 patient). In 43 episodes, angiography did not demonstrate active bleeding. Twelve (28%) of these patients continued to bleed, 9 of whom had successful surgery. Of the 38 patients who had embolizations, all had immediate cessation of bleeding. Nine patients (24%) later rebled; 5 of these patients required surgery and 3 had reembolizations. Of the 3 patients who underwent reembolization, 2 developed ischemic bowel and 1 stopped bleeding; surgery was required in 1 patient. CONCLUSIONS:Mesenteric angiography for lower gastrointestinal bleeding effectively identifies the site of bleeding in 48% of patients and allows embolization in 45%. Embolization achieves clinical success in 76% of patients but repeat embolization is associated with a high rate of complications.
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ISSN:0012-3706
1530-0358
DOI:10.1007/DCR.0b013e3181e10e90