Sildiroglu Onur, Muasher Jamil, Arslan Bulent, Sabri Saher S, Saad Wael E, Angle John F, Matsumoto Alan H, Turba Ulku C
*Department of Radiology, University of Virginia, Charlottesville, VA †Radiology, Gulhane Medical School, Istanbul, Turkey ‡Department of Interventional Radiology, Rush University Medical Center, Chicago, IL.
J Clin Gastroenterol. 2014 Sep;48(8):687-92. doi: 10.1097/MCG.0000000000000181.
To report the outcomes following catheter angiography with or without embolization in patients with acute upper gastrointestinal nonvariceal hemorrhage (UGINH).
A review of electronic medical records was performed to identify all potential patients for this study between 2001 and 2011. Patients with first-time UGINH who required angiographic localization and endovascular treatment were included. Patients with variceal bleeding and prior surgical or endovascular intervention for the gastrointestinal system were excluded. Society of Interventional Radiology guidelines and American College of Radiology "appropriateness criteria" reporting standards were followed.
We identified 74 patients (men/women=46/28) with a mean age of 60 years. Thirty-four patients were found to have active bleeding on angiography. One patient from this group did not undergo embolization because of an angiographic diagnosis of aortoenteric fistula. Technical failure was encountered in 2/34 patients; therefore, the technical success of embolization was 94%. Forty of 74 patients showed no angiographic evidence of active bleeding; 18 patients underwent prophylactic embolization using endoscopically placed clips as targets; and 22 patients had no embolotherapy. Thus, we grouped the patients into 3 groups: (1) therapeutic embolization; (2) prophylactic/empiric embolization; and (3) no embolotherapy groups. The clinical success of embolization was 67% to 68% in the therapeutic embolization group and 67% in the prophylactic embolization group. Early rebleeding rates were 33.8%, 51.6%, 33.3%, and 12% among all the patients, the therapeutic embolization group, the prophylactic embolization group, and the no endovascular treatment group, respectively. Mortality was significantly high in patients with advanced age (P=0.001), cerebrovascular disorders (P=0.037), and positive angiography (P=0.026), even when clinical success was achieved.
Acute UGINH remains a clinical challenge with increased mortality rates, even with high technical success rates. Patients with negative findings on angiography have lower early rebleeding rates than patients with active bleeding during angiography or endoscopy-guided prophylactic/empiric embolization.
报告急性上消化道非静脉曲张性出血（UGINH）患者接受导管血管造影术（无论是否进行栓塞）后的结果。
回顾2001年至2011年间的电子病历，以确定本研究的所有潜在患者。纳入首次发生UGINH且需要血管造影定位和血管内治疗的患者。排除患有静脉曲张出血以及既往有胃肠道系统手术或血管内介入治疗史的患者。遵循介入放射学会指南和美国放射学会“适宜性标准”报告标准。
我们确定了74例患者（男/女 = 46/28），平均年龄60岁。血管造影显示34例患者有活动性出血。该组中有1例患者因血管造影诊断为主动脉肠瘘未接受栓塞治疗。34例患者中有2例出现技术失败；因此，栓塞治疗的技术成功率为94%。74例患者中有40例血管造影未显示活动性出血迹象；18例患者以内镜放置的夹子为靶点进行预防性栓塞；22例患者未接受栓塞治疗。因此，我们将患者分为3组：（1）治疗性栓塞组；（2）预防性/经验性栓塞组；（3）未进行栓塞治疗组。治疗性栓塞组栓塞治疗的临床成功率为67%至68%，预防性栓塞组为67%。所有患者、治疗性栓塞组、预防性栓塞组和未进行血管内治疗组的早期再出血率分别为33.8%、51.6%、33.3%和12%。高龄患者（P = 0.001）、脑血管疾病患者（P = 0.037）以及血管造影阳性患者（P = 0.026）的死亡率显著较高，即使取得了临床成功也是如此。
急性UGINH仍然是一项临床挑战，即使技术成功率很高，死亡率仍会增加。血管造影结果为阴性的患者早期再出血率低于血管造影时有活动性出血或在内镜引导下进行预防性/经验性栓塞的患者。
