Lee Han Hee, Park Jae Myung, Chun Ho Jong, Oh Jung Suk, Ahn Hyo Jun, Choi Myung-Gyu
Department of Internal Medicine, Division of Gastroenterology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea.
Scand J Gastroenterol. 2015 Jul;50(7):809-15. doi: 10.3109/00365521.2014.990503. Epub 2015 Mar 2.
Transcatheter arterial embolization (TAE) is a therapeutic option for endoscopically unmanageable upper gastrointestinal (GI) bleeding. We aimed to assess the efficacy and clinical outcomes of TAE for acute non-variceal upper GI bleeding and to identify predictors of recurrent bleeding within 30 days.
Visceral angiography was performed in 66 patients (42 men, 24 women; mean age, 60.3 ± 12.7 years) who experienced acute non-variceal upper GI bleeding that failed to be controlled by endoscopy during a 7-year period. Clinical information was reviewed retrospectively. Outcomes included technical success rates, complications, and 30-day rebleeding and mortality rates.
TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25-15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43-17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization.
TAE controlled acute non-variceal upper GI bleeding effectively. TAE may be considered when endoscopic therapy is unavailable or unsuccessful. Correction of coagulopathy before TAE is recommended.
经导管动脉栓塞术（TAE）是治疗内镜无法处理的上消化道（GI）出血的一种治疗选择。我们旨在评估TAE治疗急性非静脉曲张性上消化道出血的疗效和临床结局，并确定30天内再出血的预测因素。
对66例患者（42例男性，24例女性；平均年龄60.3±12.7岁）进行了内脏血管造影，这些患者在7年期间发生急性非静脉曲张性上消化道出血，经内镜检查未能控制。回顾性分析临床资料。结局包括技术成功率、并发症、30天再出血率和死亡率。
59例患者可行TAE。技术成功率为98%。首次TAE后30天内47%的患者出现再出血，其中8例通过再次栓塞治疗，5例通过内镜干预，2例通过手术，12例通过保守治疗。30天总死亡率为42.4%。在初始内镜止血失败的病例（n = 34）中，31例患者接受了血管造影栓塞，其中30例成功（96.8%）。15例患者（50%）发生再出血，主要原因是恶性肿瘤。多因素分析显示，两个因素是30天内再出血的独立预测因素：凝血功能障碍（比值比[OR] = 4.37；95%置信区间[CI]：1.25 - 15.29；p = 0.021）和栓塞≥2个区域（OR = 4.93；95% CI：1.43 - 17.04；p = 0.012）。导管相关并发症包括肝动脉夹层和脾栓塞。
TAE能有效控制急性非静脉曲张性上消化道出血。在内镜治疗不可用或不成功时可考虑TAE。建议在TAE前纠正凝血功能障碍。
