Gad Sandra, Du Pisanie Lourens, Mohnasky Michael, Harris Bryan, Villalobos Alexander, Keefe Nicole, Mody Priya, Caddell Andrew, Kokabi Nima
Division of Vascular & Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
School of Medicine, St. George's University, St. George's, West Indes P.O. Box 7, Grenada.
J Clin Med. 2025 Mar 29;14(7):2345. doi: 10.3390/jcm14072345.
: To evaluate the efficacy and safety of using tantalum-loaded Obsidio conformable embolic (Ta-OCE) in gastroduodenal artery (GDA) embolization for upper gastrointestinal bleeding (UGIB), employing a novel "open-sandwich" technique. : An institutional review board (IRB)-approved retrospective analysis was conducted on patients who underwent GDA embolization for UGIB using Ta-OCE between May 2023 and June 2024, using an "open-sandwich" technique. Briefly, the retrograde sources of flow, namely the right gastroepiploic artery (RGEA), was commonly embolized with a single, usually detachable, coil at its proximal aspect. Beginning within the proximal RGEA adjacent to the coil and distal to the site of extravasation and/or an endoscopically placed clip, Ta-OCE was then instilled in a continuous fashion to the origin of GDA. Technical success was defined as complete occlusion of the target vessel without immediate procedural complications. Clinical success was assessed as the absence of rebleeding within 4 weeks post-embolization. Adverse events were evaluated using Common Toxicity Criteria for Adverse Events (v.5). : Overall, a total of 10 patients, with a mean age of 67.3 years, underwent Ta-OCE embolization for UGIB. A technical success rate of 100% was achieved with no instances of immediate procedural complications. Clinical success was achieved in eight patients (80%). Re-intervention was required in two patients in whom the proximal GDA and distal GDA/proximal RGEA were not embolized adequately, respectively. A significant change in mean hemoglobin levels was observed 24 h pre- and post-embolization, with a mean increase of 1.47 g/dL. : Despite the small sample size, lack of control group, and retrospective design, the "open-sandwich" technique combining Ta-OCE with a single coil appears to be an effective and safe method of GDA embolization in the setting of UGIB. Larger multicenter studies are needed to further evaluate the feasibility of this technique.
为评估采用载钽Obsidio适形栓塞剂（Ta - OCE）并运用一种新型“开放式三明治”技术对胃十二指肠动脉（GDA）进行栓塞治疗上消化道出血（UGIB）的疗效和安全性。对2023年5月至2024年6月期间采用Ta - OCE并运用“开放式三明治”技术对UGIB进行GDA栓塞治疗的患者进行了一项经机构审查委员会（IRB）批准的回顾性分析。简要地说，逆行血流来源，即胃网膜右动脉（RGEA），通常在其近端用单个（通常为可脱卸的）弹簧圈进行栓塞。从与弹簧圈相邻且在渗漏部位和/或内镜放置夹子部位远端的近端RGEA开始，然后将Ta - OCE以连续方式注入至GDA的起始处。技术成功定义为目标血管完全闭塞且无即刻手术并发症。临床成功评估为栓塞后4周内无再出血。使用不良事件通用毒性标准（第5版）评估不良事件。总体而言，共有10例平均年龄为67.3岁的患者接受了Ta - OCE栓塞治疗UGIB。技术成功率达到100%，无即刻手术并发症发生。8例患者（80%）取得临床成功。2例患者分别因近端GDA和远端GDA/近端RGEA未充分栓塞而需要再次干预。栓塞前后24小时观察到平均血红蛋白水平有显著变化，平均升高1.47 g/dL。尽管样本量小、缺乏对照组且为回顾性设计，但将Ta - OCE与单个弹簧圈相结合的“开放式三明治”技术似乎是UGIB情况下GDA栓塞的一种有效且安全的方法。需要更大规模的多中心研究来进一步评估该技术的可行性。
