Khazi Zain M, Marjara Jasraj, Nance Michael, Ghouri Yezaz, Hammoud Ghassan, Davis Ryan, Bhat Ambarish
Department of Radiology, University of Missouri, Columbia, Missouri, United States.
Department of Internal medicine, Mercy Hospital St. Louis, Saint Louis, Missouri, United States.
J Clin Imaging Sci. 2022 Jun 3;12:31. doi: 10.25259/JCIS_45_2022. eCollection 2022.
To determine the efficacy of gastroduodenal artery embolization (GDAE) for bleeding peptic ulcers that failed endoscopic intervention. To identify incidence and risk factors for failure of GDAE.
A retrospective review of patients who underwent GDAE for hemorrhage from peptic ulcer disease refractory to endoscopic intervention were included in the study. Refractory to endoscopic intervention was defined as persistent hemorrhage following at least two separate endoscopic sessions with two different endoscopic techniques (thermal, injection, or mechanical) or one endoscopic session with the use of two different techniques. Demographics, comorbidities, endoscopic and angiographic findings, significant post-embolization pRBC transfusion, and index GDAE failure were collected. Failure of index GDAE was defined as the need for re-intervention (repeat embolization, endoscopy, or surgery) for rebleeding or mortality within 30 days after GDAE. Multivariate analyzes were performed to identify independent predictors for failure of index GDAE.
There were 70 patients that underwent GDAE after endoscopic intervention for bleeding peptic ulcers with a technical success rate of 100%. Failure of index GDAE rate was 23% ( = 16). Multivariate analysis identified ≥2 comorbidities (odds ratio [OR]: 14.2 [1.68-19.2], = 0.023), days between endoscopy and GDAE (OR: 1.43 [1.11-2.27], = 0.028), and extravasation during angiography (OR: 6.71 [1.16-47.4], = 0.039) as independent predictors of index GDAE failure. Endoscopic Forrest classification was not a significant predictor for the failure of index GDAE ( > 0.1).
The study demonstrates safety and efficacy of GDAE for hemorrhage from PUD that is refractory to endoscopic intervention. Days between endoscopy and GDAE, high comorbidity burden, and extravasation during angiography are associated with increased risk for failure of index GDAE.
确定胃十二指肠动脉栓塞术（GDAE）对内镜干预失败的消化性溃疡出血的疗效。确定GDAE失败的发生率及危险因素。
本研究纳入了因内镜干预难以控制的消化性溃疡出血而接受GDAE治疗的患者的回顾性分析。内镜干预难以控制定义为至少两次分别采用两种不同内镜技术（热凝、注射或机械）或一次采用两种不同技术的内镜检查后仍持续出血。收集患者的人口统计学资料、合并症、内镜和血管造影结果、栓塞后大量红细胞输注情况以及首次GDAE失败情况。首次GDAE失败定义为在GDAE后30天内因再出血或死亡而需要再次干预（重复栓塞、内镜检查或手术）。进行多变量分析以确定首次GDAE失败的独立预测因素。
70例消化性溃疡出血患者在内镜干预后接受了GDAE治疗，技术成功率为100%。首次GDAE失败率为23%（n = 16）。多变量分析确定合并症≥2种（比值比[OR]：14.2[1.68 - 19.2]，P = 0.023）、内镜检查与GDAE之间的天数（OR：1.43[1.11 - 2.27]，P = 0.028）以及血管造影期间的造影剂外渗（OR：6.71[1.16 - 47.4]，P = 0.039）是首次GDAE失败的独立预测因素。内镜Forrest分级不是首次GDAE失败的显著预测因素（P > 0.1）。
本研究证明了GDAE对内镜干预难以控制的消化性溃疡出血的安全性和有效性。内镜检查与GDAE之间的天数、高合并症负担以及血管造影期间的造影剂外渗与首次GDAE失败风险增加相关。
