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CardioVascular and Interventional Radiology

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01-09-2018 | Clinical Investigation

Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene–Vinyl Alcohol Copolymer as Safe as Coils?

Authors: Marcello Andrea Tipaldi, Gianluigi Orgera, Miltiadis Krokidis, Alberto Rebonato, Daniele Maiettini, Simone Vagnarelli, Cesare Ambrogi, Michele Rossi

Published in: CardioVascular and Interventional Radiology | Issue 9/2018

Abstract

Purpose

The safety of liquid embolics over the conventional coils for the treatment of non-variceal upper gastrointestinal bleeding (UGIB) approach is still unclear. Purpose of this study is to assess the safety of ethylene–vinyl alcohol copolymer (EVOH 6%) over coils in the treatment of UGIB.

Materials and Methods

All the upper gastrointestinal tract embolization procedures performed in a single center in a 6-year period were reviewed. Patients embolised with coils (Group A) versus those embolised with EVOH 6% (Group B) were compared. Technical/clinical success, bleeding recurrence, complication and mortality rates were analyzed.

Results

A total 71 patients were included in the study (41 Group A and 30 Group B). Coagulopathy was present in 21% of Group A and 46% of Group B patients (p < 0.05). Technical and clinical success was 97.6 and 92.7% for Group A, and 100 and 93.3% for Group B respectively, (p > 0.05). Ten patients (17% Group A; 10% Group B) re-bled within the first 36 h and all of them were re-treated successfully with a second embolization. In Group A one major complication (bowel ischemia) occurred. No complication occurred in Group B. The survival rate in the first 30 days was 90.3% for group A and 90% for group B (p > 0.05).

Conclusion

This study demonstrated EVOH 6% appears to be as safe and effective as coils in the treatment of non-variceal UGIB.

Lu Y, Loffroy R, Lau JYW, et al. Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding. BJS. 2014;101:34–50.CrossRef

Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014;43:739–52.CrossRefPubMed

Ripoll C, Bañares R, Beceiro I, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol. 2004;15:447–50.CrossRefPubMed

Kim PH, Tsauo J, Shin JH, et al. Transcatheter arterial embolization of gastrointestinal bleeding with n-butyl cyanoacrylate: a systematic review and meta-analysis of safety and efficacy. J Vasc Interv Radiol. 2017;28:522–31.CrossRefPubMed

Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.CrossRefPubMed

Rossi M, Varano GM, Orgera G, et al. Wide-neck renal artery aneurysm: parenchymal sparing endovascular treatment with a new device. BMC Urol. 2014;14:42.CrossRefPubMedPubMedCentral

Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrage: comparison of vasopressin infusion and embolization. Am J Roentgenol. 1986;146:1031–7.CrossRef

Orgera G, Tipaldi MA, Zaman I, et al. Peripheral use of detachable coils: expanding the boundaries of embolization. Minerva Cardioangiol. 2017;65:52–60.PubMed

Valek V, Husty J. Quality improvement guidelines for transcatheter embolization for acute gastrointestinal nonvariceal hemorrhage. Cardiovasc Intervent Radiol. 2013;36:608–12.CrossRefPubMed

10.

Van Vugt R, Bosska R, Van Muster IP, et al. Embolization as treatment of choice for bleeding peptic ulcers in high risk patients. Dig Surg. 2009;26:37–42.CrossRefPubMed

11.

Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrage: outcome assessment. J Vasc Interv Radiol. 2001;12:195–200.CrossRefPubMed

12.

Loffroy R, Guiu B, D’Athis P, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7:515–23.CrossRefPubMed

13.

Abdulmalak G, Chevallier O, Falvo N, et al. Safety and efficacy of transcatheter embolization with Glubran^®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients. Abdom Radiol (NY). 2017 https://doi.org/10.1007/s00261-017-1267-4. [Epub ahead of print].

14.

Loffroy R, Favelier S, Pottecher P, et al. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: indications, techniques and outcomes. Diagn Interv Imaging. 2015;96:731–44.CrossRefPubMed

15.

Yu-Sen H, Chin-Chen C, Jyh-Ming L, et al. Transcatheter arterial embolization with n-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically un-stable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol. 2014;25:1850–7.CrossRef

16.

Guimaraes M, Wooster M. Onyx (ethylene–vinyl alcohol copolymer) in peripheral applications. Semin Intervent Radiol. 2011;28:350–6.CrossRefPubMedPubMedCentral

17.

Sun CJ, Wang CE, Wang YH, et al. Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx. Indian J Cancer. 2014;51:56–9.CrossRef

18.

Urbano J, Manuel Cabrera J, Franco A, et al. Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol. 2014;25:839–46.CrossRefPubMed

Title: Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene–Vinyl Alcohol Copolymer as Safe as Coils?
Authors: Marcello Andrea Tipaldi
Gianluigi Orgera
Miltiadis Krokidis
Alberto Rebonato
Daniele Maiettini
Simone Vagnarelli
Cesare Ambrogi
Michele Rossi
Publication date: 01-09-2018
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 9/2018
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-018-1981-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene–Vinyl Alcohol Copolymer as Safe as Coils?

Abstract

Purpose

Materials and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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