Outcome of Endovascular Treatment in Acute Gastrointestinal Bleeding Referred to Rehman Medical Institute, Peshawar

Objectives: The purpose of this study was to find the outcome of endovascular treatment in cases of acute gastrointestinal (GI) bleeding due to different etiologies. Methods: It is prospective evaluation of transarterial embolization done for acute GI hemorrhage at the Radiology Department of Rehman Medical Institute (RMI), Peshawar, from March 2016 to April 2019. A total of seven cases with GI bleed were included, four of which were female and three were male, with a mean age of 50 years and median of 48. Five patients were with lower GI bleed and two had upper GI hemorrhage. For knowledge of vascular anatomy or the presence of any variants, computed tomographic angiography was performed in all cases. The patients were treated with superselective transarterial embolization under fluoroscopic guidance (Siemens ARTIS ZEE) at RMI angiography suite. Embolization materials used were coils, particles, gel foam, and amplazer plugs. Results: All the seven patients were embolized, with five having lower GI causes and two with upper GI causes. Six patients had vascular causes of hemorrhage, i.e., Arteriovenous malformations, angiodysplasia, and dieulafoy. One patient had a tumoral bleed from duodenal mass. Six patients were embolized with curative intent, whereas one patient with bleeding duodenal mass was embolized preoperatively, just before the surgery. Coils of different sizes were used in all cases. Technical success, immediate clinical success, and late success on follow-up of 1 year were recorded in all cases. Technical success in arresting hemorrhage was achieved in all cases. 0% in-hospital mortality was recorded in all cases. Conclusion: We concluded from our results that endovascular embolization is a management of choice in cases with acute GI bleeding, after endoscopic attempts have failed/deemed inappropriate. Endovascular treatment is a safe and effective technique with a small associated risk of morbidity. Risk of further bleeding is small with vast majority of patients achieving resolution of symptoms.

 

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Publication History

Article published online:
26 April 2021