Upper gastrointestinal hemorrhage and transcatheter embolotherapy: Clinical and technical factors impacting success and survival

PURPOSE: To identify clinical and technical factors influencing the outcome of transcatheter embolotherapy for nonvariceal upper gastrointestinal (GI) hemorrhage and to quantify the impact of successful intervention on patien t survival. MATERIALS AND METHODS: A retrospective review was performed of all patients (n = 163) who underwent arterial embolization for acute upper GI hemorrhag e at a university hospital over an 11.5-year period. Clinical success was d efined as target area devascularization that resulted in the clinical cessa tion of bleeding and stabilization of hemoglobin level. The clinical condit ion of each patient at intervention was defined by history, laboratory exam ination, and two composite indicator variables. With use of logistic regres sion, the dependent variable, clinical success, was modeled on two categori es of clinical and technical variables. A final model regressed patient sur vival on clinical success and other clinical variables. RESULTS: None of the procedural variables analyzed had a significant influe nce on clinical success. Several clinical variables did impact clinical suc cess, including multiorgan system failure (OR, 0.36; P = .030), coagulopath y (OR, 0.36; P = .026), and bleeding subsequent to trauma (OR, 7.1; P = .04 0) or invasive procedures (OR, 6.5; P = .009). Regardless of their clinical condition at intervention, patients who! underwent clinically successful e mbolization were 13.3 times more likely to survive than those who had an un successful procedure (Cl, 4.54-39.2; P = .000). Nevertheless, patients with multiorgan system failure were 17.5 times more likely to die, independent of the outcome of the procedure (Cl, 0.014-0.229; P = .000). CONCLUSION: Arresting nonvariceal upper GI hemorrhage with transcatheter em bolotherapy has a large positive effect on patient survival, independent of clinical condition or demonstrable extravasation at intervention. Aggressi ve treatment with transcatheter embolotherapy is advisable in patients with acute nonvariceal upper GI hemorrhage.