Penn Image-Guided Interventions Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Penn Image-Guided Interventions Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2023 Jun;34(6):1062-1069. doi: 10.1016/j.jvir.2023.01.026. Epub 2023 Feb 3.
To evaluate gastric and intestinal mucosal changes on postembolic endoscopy and mortality after transarterial embolization (TAE) for upper gastrointestinal bleeding (UGIB).
An institutional review board-approved retrospective review of patients who underwent arteriography for refractory UGIB at a multicenter health system from December 2003 to August 2019 was performed. Two hundred sixty-nine patients underwent TAE for UGIB. Data on etiology of bleeding, embolization technique, pre-embolic and postembolic endoscopic results, blood product requirements, and mortality were collected from the medical record. Endoscopy results were compared at the site of the target lesion before and after TAE. Multivariable logistic regressions were performed to assess predictors of new adverse mucosal responses and mortality.
The most common etiology of UGIB was peptic ulcer. Twenty-five percent (n = 68) of the patients had clinical evidence of rebleeding after TAE, and the 30-day mortality rate was 26% (n = 73). Eighty-eight (32%) patients underwent post-TAE endoscopy, with only 15% showing new adverse mucosal changes after embolization. Procedural characteristics, including vascular territory and embolic choice, were not significantly predictive of increased risk of development of adverse mucosal response after TAE or increased mortality risk. No patients in the study were found to have bowel lumen stenosis at the time of post-TAE endoscopy or at 6 year follow-up.
TAE is a safe and effective intervention for patients with UGIB. Post-TAE endoscopy demonstrated that most patients had either stability or improvement in the target lesion after TAE, and only a minority of patients demonstrated adverse mucosal changes.
评估经动脉栓塞（TAE）治疗上消化道出血（UGIB）后内镜下胃和肠黏膜变化与死亡率。
对 2003 年 12 月至 2019 年 8 月期间在一个多中心医疗系统因难治性 UGIB 而行血管造影的患者进行了机构审查委员会批准的回顾性研究。269 例 UGIB 患者接受了 TAE。从病历中收集了出血病因、栓塞技术、栓塞前和栓塞后内镜结果、血制品需求和死亡率的数据。在 TAE 前后，比较了目标病变部位的内镜结果。采用多变量逻辑回归评估新的不良黏膜反应和死亡率的预测因素。
UGIB 的最常见病因是消化性溃疡。25%（n=68）的患者 TAE 后有临床再出血证据，30 天死亡率为 26%（n=73）。88 例（32%）患者接受了 TAE 后内镜检查，只有 15%的患者在栓塞后出现新的不良黏膜变化。包括血管区域和栓塞选择在内的操作特征与 TAE 后不良黏膜反应风险增加或死亡率风险增加无显著相关性。在 TAE 后内镜检查或 6 年随访时，研究中没有患者发现肠腔狭窄。
TAE 是治疗 UGIB 的安全有效的方法。TAE 后内镜检查显示，大多数患者的目标病变在 TAE 后稳定或改善，只有少数患者出现不良黏膜变化。
