Role of angiography and embolization for massive gastroduodenal hemorrhage

The role of mesenteric angiography and embolization for massive gastroduode nal bleeding is unclear. We reviewed the records of patients who underwent angiography for acute, nonmalignant, and nonvariceal gastric or duodenal he morrhage that was documented but not controlled by endoscopy. Fifty patient s were identified over a 7-year period ending in March 1998. Only 17 patien ts (34%) were originally admitted to the hospital with gastrointestinal ble eding. All required treatment in the intensive care unit (mean 15 days) wit h a mean APACHE III score of 79 (29% predicted hospital mortality), and 32 (64%) had organ failure. A mean of 2.1 endoscopies were performed to locate the source of acute duodenal bleeding in 37 (74%) and gastric bleeding in 13 (26%). An average of 24.3 units of packed red blood cells were transfuse d per patient. Twenty-five patients (50%) were found to have active bleedin g at angiography; all were treated by embolization as were 22 who underwent empiric embolization. Twenty-six patients (52%) were successfully treated by embolization and thus spared imminent surgery. Multiple variables were c ompared between those who were successfully treated by embolization and tho se considered failures. Time to angiography was considerably shorter (2.5 v s. 5.8 days, P <0.017) and fewer total units of packed red blood cells were used (14.6 vs. 34, P <0.003) in those who were successfully treated. There was also a strong trend toward using fewer units of packed red blood cells for transfusion prior to angiography (11.2 vs. 17.1, P <0.08). No differen ces were found that could be attributed to gastric vs, duodenal sources, nu mber of comorbid diseases, organ failure, APACHE score, age, or whether act ive bleeding was found at angiography A total of 20 patients (40%) died inc luding 9 of 17 patients operated on in an attempt to salvage angiographic f ailure. In summary, angiographic embolization should be performed early in the course of bleeding in otherwise critically ill patients.