Skip to main content
Erschienen in: CardioVascular and Interventional Radiology 9/2018

10.05.2018 | Clinical Investigation

Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene–Vinyl Alcohol Copolymer as Safe as Coils?

verfasst von: Marcello Andrea Tipaldi, Gianluigi Orgera, Miltiadis Krokidis, Alberto Rebonato, Daniele Maiettini, Simone Vagnarelli, Cesare Ambrogi, Michele Rossi

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The safety of liquid embolics over the conventional coils for the treatment of non-variceal upper gastrointestinal bleeding (UGIB) approach is still unclear. Purpose of this study is to assess the safety of ethylene–vinyl alcohol copolymer (EVOH 6%) over coils in the treatment of UGIB.

Materials and Methods

All the upper gastrointestinal tract embolization procedures performed in a single center in a 6-year period were reviewed. Patients embolised with coils (Group A) versus those embolised with EVOH 6% (Group B) were compared. Technical/clinical success, bleeding recurrence, complication and mortality rates were analyzed.

Results

A total 71 patients were included in the study (41 Group A and 30 Group B). Coagulopathy was present in 21% of Group A and 46% of Group B patients (p < 0.05). Technical and clinical success was 97.6 and 92.7% for Group A, and 100 and 93.3% for Group B respectively, (p > 0.05). Ten patients (17% Group A; 10% Group B) re-bled within the first 36 h and all of them were re-treated successfully with a second embolization. In Group A one major complication (bowel ischemia) occurred. No complication occurred in Group B. The survival rate in the first 30 days was 90.3% for group A and 90% for group B (p > 0.05).

Conclusion

This study demonstrated EVOH 6% appears to be as safe and effective as coils in the treatment of non-variceal UGIB.
Literatur
1.
Zurück zum Zitat Lu Y, Loffroy R, Lau JYW, et al. Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding. BJS. 2014;101:34–50.CrossRef Lu Y, Loffroy R, Lau JYW, et al. Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding. BJS. 2014;101:34–50.CrossRef
2.
Zurück zum Zitat Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014;43:739–52.CrossRefPubMed Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014;43:739–52.CrossRefPubMed
3.
Zurück zum Zitat Ripoll C, Bañares R, Beceiro I, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol. 2004;15:447–50.CrossRefPubMed Ripoll C, Bañares R, Beceiro I, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol. 2004;15:447–50.CrossRefPubMed
4.
Zurück zum Zitat Kim PH, Tsauo J, Shin JH, et al. Transcatheter arterial embolization of gastrointestinal bleeding with n-butyl cyanoacrylate: a systematic review and meta-analysis of safety and efficacy. J Vasc Interv Radiol. 2017;28:522–31.CrossRefPubMed Kim PH, Tsauo J, Shin JH, et al. Transcatheter arterial embolization of gastrointestinal bleeding with n-butyl cyanoacrylate: a systematic review and meta-analysis of safety and efficacy. J Vasc Interv Radiol. 2017;28:522–31.CrossRefPubMed
5.
Zurück zum Zitat Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.CrossRefPubMed Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.CrossRefPubMed
6.
Zurück zum Zitat Rossi M, Varano GM, Orgera G, et al. Wide-neck renal artery aneurysm: parenchymal sparing endovascular treatment with a new device. BMC Urol. 2014;14:42.CrossRefPubMedPubMedCentral Rossi M, Varano GM, Orgera G, et al. Wide-neck renal artery aneurysm: parenchymal sparing endovascular treatment with a new device. BMC Urol. 2014;14:42.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrage: comparison of vasopressin infusion and embolization. Am J Roentgenol. 1986;146:1031–7.CrossRef Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrage: comparison of vasopressin infusion and embolization. Am J Roentgenol. 1986;146:1031–7.CrossRef
8.
Zurück zum Zitat Orgera G, Tipaldi MA, Zaman I, et al. Peripheral use of detachable coils: expanding the boundaries of embolization. Minerva Cardioangiol. 2017;65:52–60.PubMed Orgera G, Tipaldi MA, Zaman I, et al. Peripheral use of detachable coils: expanding the boundaries of embolization. Minerva Cardioangiol. 2017;65:52–60.PubMed
9.
Zurück zum Zitat Valek V, Husty J. Quality improvement guidelines for transcatheter embolization for acute gastrointestinal nonvariceal hemorrhage. Cardiovasc Intervent Radiol. 2013;36:608–12.CrossRefPubMed Valek V, Husty J. Quality improvement guidelines for transcatheter embolization for acute gastrointestinal nonvariceal hemorrhage. Cardiovasc Intervent Radiol. 2013;36:608–12.CrossRefPubMed
10.
Zurück zum Zitat Van Vugt R, Bosska R, Van Muster IP, et al. Embolization as treatment of choice for bleeding peptic ulcers in high risk patients. Dig Surg. 2009;26:37–42.CrossRefPubMed Van Vugt R, Bosska R, Van Muster IP, et al. Embolization as treatment of choice for bleeding peptic ulcers in high risk patients. Dig Surg. 2009;26:37–42.CrossRefPubMed
11.
Zurück zum Zitat Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrage: outcome assessment. J Vasc Interv Radiol. 2001;12:195–200.CrossRefPubMed Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrage: outcome assessment. J Vasc Interv Radiol. 2001;12:195–200.CrossRefPubMed
12.
Zurück zum Zitat Loffroy R, Guiu B, D’Athis P, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7:515–23.CrossRefPubMed Loffroy R, Guiu B, D’Athis P, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7:515–23.CrossRefPubMed
13.
Zurück zum Zitat Abdulmalak G, Chevallier O, Falvo N, et al. Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients. Abdom Radiol (NY). 2017 https://doi.org/10.1007/s00261-017-1267-4. [Epub ahead of print]. Abdulmalak G, Chevallier O, Falvo N, et al. Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients. Abdom Radiol (NY). 2017 https://​doi.​org/​10.​1007/​s00261-017-1267-4. [Epub ahead of print].
14.
Zurück zum Zitat Loffroy R, Favelier S, Pottecher P, et al. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: indications, techniques and outcomes. Diagn Interv Imaging. 2015;96:731–44.CrossRefPubMed Loffroy R, Favelier S, Pottecher P, et al. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: indications, techniques and outcomes. Diagn Interv Imaging. 2015;96:731–44.CrossRefPubMed
15.
Zurück zum Zitat Yu-Sen H, Chin-Chen C, Jyh-Ming L, et al. Transcatheter arterial embolization with n-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically un-stable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol. 2014;25:1850–7.CrossRef Yu-Sen H, Chin-Chen C, Jyh-Ming L, et al. Transcatheter arterial embolization with n-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically un-stable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol. 2014;25:1850–7.CrossRef
16.
17.
Zurück zum Zitat Sun CJ, Wang CE, Wang YH, et al. Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx. Indian J Cancer. 2014;51:56–9.CrossRef Sun CJ, Wang CE, Wang YH, et al. Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx. Indian J Cancer. 2014;51:56–9.CrossRef
18.
Zurück zum Zitat Urbano J, Manuel Cabrera J, Franco A, et al. Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol. 2014;25:839–46.CrossRefPubMed Urbano J, Manuel Cabrera J, Franco A, et al. Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol. 2014;25:839–46.CrossRefPubMed
Metadaten
Titel
Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene–Vinyl Alcohol Copolymer as Safe as Coils?
verfasst von
Marcello Andrea Tipaldi
Gianluigi Orgera
Miltiadis Krokidis
Alberto Rebonato
Daniele Maiettini
Simone Vagnarelli
Cesare Ambrogi
Michele Rossi
Publikationsdatum
10.05.2018
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 9/2018
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-1981-5

Weitere Artikel der Ausgabe 9/2018

CardioVascular and Interventional Radiology 9/2018 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.