Kim Sang Yoon, Kim Su Jin, Lee Ayoung, Yoon Kichul, Park Jun Young, Lee Ju Yup, Park Jae Myung
Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan, Korea.
Korean J Helicobacter Up Gastrointest Res. 2023 Mar;23(1):52-62. doi: 10.7704/kjhugr.2022.0054. Epub 2023 Mar 6.
BACKGROUND/AIMS: Transcatheter arterial embolization (TAE) is useful for management of uncontrolled upper gastrointestinal (UGI) bleeding. We investigated clinical outcomes of TAE for non-variceal bleeding from benign UGI diseases uncontrolled with endoscopic intervention.
This retrospective study performed between 2017 and 2021 across four South Korean hospitals. Ninety-two patients (72 men, 20 women) who underwent angiography were included after the failure of endoscopic intervention for benign UGI disease- induced acute non-variceal bleeding. We investigated the factors associated with endoscopic hemostasis failure, the technical success rate of TAE, and post-TAE 30-day rebleeding and mortality rates.
The stomach (52/92, 56.5%) and duodenum (40/92, 43.5%) were the most common sites of bleeding. Failure of endoscopic procedures was attributable to peptic ulcer disease (81/92, 88.0%), followed by pseudo-aneurysm (5/92, 5.4%), and angiodysplasia (2/92, 2.2%). Massive bleeding that interfered with optimal visualization of the endoscopic field was the most common indication for TAE both in the stomach (22/52, 42.3%) and duodenum (14/40, 35.0%). Targeted TAE, empirical TAE, and exclusive arteriography were performed in 77 (83.7%), nine (9.8%), and six patients (6.5%), respectively. The technical success rate, the post-TAE 30-day rebleeding rate, and the overall mortality rate were 100%, 22.1%, and 5.8%, respectively. On multivariate analysis, coagulopathy (OR, 5.66; 95% CI, 1.7118.74; =0.005) and empirical embolization (OR, 5.71; 95% CI, 1.1428.65; =0.034) were independent risk factors for post-TAE 30-day rebleeding episodes.
TAE may be useful for acute non-variceal UGI bleeding. Targeted embolization and correction of coagulopathy can improve clinical outcomes.
背景/目的：经导管动脉栓塞术（TAE）可用于治疗难以控制的上消化道（UGI）出血。我们研究了TAE治疗经内镜干预仍无法控制的良性UGI疾病所致非静脉曲张性出血的临床结局。
这项回顾性研究于2017年至2021年在韩国四家医院开展。92例接受血管造影的患者（72例男性，20例女性）在内镜干预治疗良性UGI疾病引起的急性非静脉曲张性出血失败后被纳入研究。我们调查了与内镜止血失败相关的因素、TAE的技术成功率以及TAE术后30天再出血率和死亡率。
胃（52/92，56.5%）和十二指肠（40/92，43.5%）是最常见的出血部位。内镜手术失败归因于消化性溃疡病（81/92，88.0%），其次是假性动脉瘤（5/92，5.4%）和血管发育异常（2/92，2.2%）。干扰内镜视野最佳观察的大量出血是胃（22/52，42.3%）和十二指肠（14/40，35.0%）TAE最常见的指征。分别有77例（83.7%）、9例（9.8%）和6例患者（6.5%）接受了靶向TAE、经验性TAE和单纯血管造影。技术成功率、TAE术后30天再出血率和总死亡率分别为100%、22.1%和5.8%。多因素分析显示，凝血功能障碍（OR，5.66；95%CI，1.7118.74；P=0.005）和经验性栓塞（OR，5.71；95%CI，1.1428.65；P=0.034）是TAE术后30天再出血事件的独立危险因素。
TAE可能对急性非静脉曲张性UGI出血有用。靶向栓塞和纠正凝血功能障碍可改善临床结局。
