Embolization for gastrointestinal hemorrhages

Retrospective evaluation of interventional embolization therapy in the trea tment of gastrointestinal hemorrhage over a long-term observation period fr om 1989 to 1997. Included in the study were 35 patients (age range 18-89 ye ars) with gastrointestinal bleeding (GI) referred for radiological interven tion either primarily or following unsuccessful endoscopy Surgery. Sources of GI bleeding included gastric Id duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wail secondary to malignancy (n = 6), vascu lar malformations (n = 4), and hemorrhoids (n = 2), as well as from postope rative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predomin antly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally , polyvinyl alcohol particles, a red stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 3 5 cases (83%). In one case (3%) the source of bleeding was recognized but t he corresponding vessel could not be catheterized. In five or cases (14%) t here was partial success with reduced though still persistent, bleeding. Th e rate of complications was 14%, including four instances of intestinal isc hemia with fatal outcome in the first ears, and, later, one partial infarct ion of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriousl y ill and those who lad invasive interventional techniques. The ability of minicoils instead of fluid embolization agents has reduced the risk of seri ous complications.