- Email: [email protected]
Acute gastrointestinal bleeding: A slowly changing paradigm
Diagnostic and Interventional Imaging (2017) , 1—3
EDITORIAL
Acute gastrointestinal bleeding: A slowly changing paradigm
KEYWORDS Acute gastrointestinal bleeding; Interventional Imaging; Arterial embolization
Gastrointestinal bleeding is classically defined according to the location of its cause. Accordingly, upper gastrointestinal bleeding originates from a cause located between the oral cavity and the angle of Treitz whereas lower gastrointestinal bleeding arises from the segment between the angle of Treitz and the anus [1]. Recently, it has been suggested to classify gastrointestinal bleedings into three categories: upper, middle and lower, with the middle one originating from the small bowel only [2]. Mortality from acute overt gastrointestinal bleeding (AOGIB) has been estimated to 10% and dramatically rises up to 21—40% in patients with massive AOGIB [3—5]. Consequently, prompt diagnosis of AOGIB and identification of the cause and location is mandatory to avoid delay in appropriate management. Several studies have investigated the performances of computed tomography (CT) in the diagnosis of gastrointestinal bleeding [6—11]. CT is used as the first line diagnostic modality at many institutions in patients with acute overt gastrointestinal bleeding [12—16] although guidelines from gastrointestinal societies still consider that endoscopy should be performed first [17,18]. In the same time, appropriate management of acute gastrointestinal bleeding has been subjected to dramatic changes. Surgery has been considered as the reference treatment for many years [19], but percutaneous arterial embolization, when possible, is now considered as the first line treatment at many facilities, even in hemodynamically instable patients [20]. CT can depict active contrast extravasation in patients with life-threatening AOGIB. Diagnostic performance has been improved by the use of multiplanar and maximum intensity projection (MIP) reformations from submillimeter isotropic voxels [12]. In a metaanalysis, Garcia-Blazquez et al., found an overall sensitivity of CT angiography for depicting active gastrointestinal bleeding of 85.2% (95% CI 75.5% to 91.5%) and a specificity of 92.1% (95% CI 76.7% to 97.7%) [6]. Marti et al. reported a correct identification of the causative lesion in 39/47 patients (83%) [7]. It is now well established that CT is superior to nuclear red blood cell scan for the evaluation of lower gastrointestinal bleeding [17]. CT decreases scanning time, allows accurate acquisition of CT images obtained during the arterial time and demonstrates contrast material extravasation into any portion of the gastrointestinal tract. CT has therefore replaced the nuclear red blood cell scan in many centers [17].
http://dx.doi.org/10.1016/j.diii.2017.05.005 2211-5684/© 2017 Published by Elsevier Masson SAS on behalf of Editions franc ¸aises de radiologie.
2 Percutaneous arterial embolization is a well-established technique for the treatment of acute bleeding in a variety of locations [21—24]. More specifically, percutaneous arterial embolization has demonstrated clinical efficacy ranging from 71% to 100% in the management of acute lower gastrointestinal bleeding [25,26]. The technical success ranges between 73% and 100% depending on the presence of arterial vasospasm, atheromatous lesions, vessel tortuosity on the bleeding arteries [25,26]. In embolized patients, immediate hemostasis is achieved in 95% of them [25]. The rate of recurrence may reach up to 21% [25,26], the site of recurrence can be either the embolization site in 45%, a distinct site in 16% or an undetectable site in 39% of patients [25]. In this issue of Diagnostic & Interventional Imaging, BuaNgam et al. have reported the results of a study that was aimed at assessing the safety and efficacy of percutaneous arterial embolization in the treatment of acute lower gastrointestinal bleeding (LGIB) and to determine the potential factors that influence treatment outcome [27]. Thirty-eight patients with acute LGIB who were treated by percutaneous arterial embolization were retrospectively included [27]. Technical success of percutaneous arterial embolization was obtained in 35/38 patients (92%) whereas technical failure was observed in 3/38 patients (8%). Technical failure was due to vessel tortuosity and vasospasm [27]. The clinical success rate following percutaneous arterial embolization was 63% [27]. Of interest, among the 10 patients with clinical failure, 9 received gelatin sponge as embolic material, thus questioning the use of this embolic agent in acute LGIB by comparison with glue and metallic coils [28,29]. In the study by Bua-Ngam et al., bowel ischemia following percutaneous arterial embolization occurred in 5/38 patients (13%); mild ischemia without sequelae was observed in three patients and severe ischemia with bowel perforation requiring surgery in two patients [27]. These results are consistent with those of prior studies [30—32]. Of interest, Bua-Ngam et al. used gelatin sponge in 4 out 5 patients with ischemic complications. In their study, Bua-Ngam et al. did not identify variables that were significantly predictive for a failed percutaneous arterial embolization, although a trend toward an association was found between technical failure of percutaneous arterial embolization and comorbidities (OR, 0.12) and international normalized ratio > 1.3 (OR, 7.04) and a trend toward an association between clinical failure of percutaneous arterial embolization and hypovolemic shock (OR, 5.00) [27]. The study by Bua-Ngam et al., reinforces the general assumption that percutaneous arterial embolization has a high efficacy in the treatment of acute LGIB with an acceptable rate of complications. However, several questions remain unanswered, especially regarding the best embolic agent in this situation and the identification of predictive variables of failed percutaneous arterial embolization. These important questions should stimulate further prospective, multicenter and large-scale studies.
Disclosure of interest The authors declare that they have no competing interest.
Editorial
References [1] Ramaswamy RS, Choi HW, Mouser HC, Narsinh KH, McCammack KC, Treesit T, et al. Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol 2014;6:82—92. [2] Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009;6:637—46. [3] Sanders DS, Perry MJ, Jones SG, McFarlane E, Johnson AG, Gleeson DC, et al. Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. Eur J Gastroenterol Hepatol 2004;16:487—94. [4] van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494—9. [5] Hreinsson JP, Kalaitzakis E, Gudmundsson S, Bjornsson ES. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol 2013;48:439—47. [6] Garcia-Blazquez V, Vicente-Bartulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013;23:1181—90. [7] Marti M, Artigas JM, Garzon G, Alvarez-Sala R, Soto JA. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology 2012;262:109—16. [8] Yamaguchi T, Yoshikawa K, Enhanced CT. for initial localization of active lower gastrointestinal bleeding. Abdom Imaging 2003;28:634—6. [9] Stuber T, Hoffmann MH, Stuber G, Klass O, Feuerlein S, Aschoff AJ. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT. Abdom Imaging 2009;34:476—82. [10] Yoon W, Jeong YY, Kim JK. Acute gastrointestinal bleeding: contrast-enhanced MDCT. Abdom Imaging 2006;31:1—8. [11] Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 2006;239:160—7. [12] Duchat F, Soyer P, Boudiaf M, Martin-Grivaud S, Fargeaudou Y, Malzy P, et al. Multi-detector row CT of patients with acute intestinal bleeding: a new perspective using multiplanar and MIP reformations from submillimeter isotropic voxels. Abdom Imaging 2010;35:296—305. [13] Dohan A, Dautry R, Guerrache Y, Fargeaudou Y, Boudiaf M, Le Dref O, et al. Three-dimensional MDCT angiography of splanchnic arteries: pearls and pitfalls. Diagn Interv Imaging 2015;96:187—200. [14] Dohan A, Eveno C, Guerrache Y, Dautry R, Soyer P. Aortojejunal fistula causing obscure massive gastrointestinal bleeding: repeated CT is the key. Diagn Interv Imaging 2015;96:97—8. [15] Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics 2007;27:1055—70. [16] Kim JW, Shin SS, Yoon W, Chang NK, Heo SH, Jeong YY, et al. Diagnosis of acute gastrointestinal bleeding: comparison of the arterial, the portal, and the combined set using 64-section computed tomography. J Comput Assist Tomogr 2011;35:206—11. [17] Standards of Practice ASGE, Committee, Pasha SF, Shergill A, Acosta RD, Chandrasekhara V, Chathadi KV, Early D, et al. The
Editorial
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014;79:875—85. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015;110:1265—87. Schuetz A, Jauch KW. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbecks Arch Surg 2001;386:17—25. Dohan A, Eveno C, Dautry R, Guerrache Y, Camus M, Boudiaf M, et al. Role and effectiveness of percutaneous arterial embolization in hemodynamically unstable patients with ruptured splanchnic artery pseudoaneurysms. Cardiovasc Intervent Radiol 2015;38:862—70. Pelage JP, Le Dref O, Jacob D, Soyer P, Rossignol M, Truc J, et al. Uterine artery embolization: anatomical and technical considerations, indications, results, and complications. J Radiol 2000;81:1863—72. Gaudon C, Soussan J, Louis G, Moutardier V, Gregoire E, Vidal V. Late postpancreatectomy hemorrhage: predictive factors of morbidity and mortality after percutaneous endovascular treatment. Diagn Interv Imaging 2016;97:1071—7. Korkmaz M, ¸ Sanal B, Aras B, Bozkaya H, C ¸ ınar C, Güneyli S, et al. The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria. Diagn Interv Imaging 2016;97:197—201. Zandrino F, Tettoni SM, Gallesio I, Summa M. Emergency arterial embolization of upper gastrointestinal and jejunal tumors: an analysis of 12 patients with severe bleeding. Diagn Interv Imaging 2017;98:51—6. Weldon DT, Burke SJ, Sun S, Mimura H, Golzarian J. Interventional management of lower gastrointestinal bleeding. Eur Radiol 2008;18:857—67. Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009;104:2042—6. Bua-Ngam C, Norasetsingh J, Treesit T, Wedsart B, Chansanti O, Tapaneeyakorn J, et al. Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding:
3
[28]
[29]
[30]
[31]
[32]
a single-center experience. Diagn Interv Imaging 2017, http://dx.doi.org/10.1016/j.diii.2017.02.005. Yonemitsu T, Kawai N, Sato M, Tanihata H, Takasaka I, Nakai M, Minamiguchi H, Sahara S, Iwasaki Y, Shima Y, Shinozaki M, Naka T, Shinozaki M. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 2009;20: 1176—87. ® ® ® Loffroy R. Glubran2 , Histoacryl or Trufill : which cyanoacrylate glue for endovascular use? Diagn Interv Imaging 2016;97:119. Kwak HS, Han YM, Lee ST. The clinical outcomes of transcatheter microcoil embolization in patients with active lower gastrointestinal bleeding in the small bowel. Korean J Radiol 2009;10:391—7. Hur S, Jae HJ, Lee M, Kim HC, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol 2014;25:10—9. Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2003;14:1503—9.
P. Soyer (MD, PhD) a,∗ , A. Fohlen (MD) b , A. Dohan (MD, PhD) c a
Université Diderot-Paris-7, AP — HP, Paris, France b Department of diagnostic imaging and interventional radiology, centre hospitalier universitaire de Caen, Caen, France c Department of diagnostic radiology, royal victoria hospital, McGill university health centre, Montreal, QC, Canada ∗ Corresponding
author.
E-mail address: [email protected] (P. Soyer)
EDITORIAL
Acute gastrointestinal bleeding: A slowly changing paradigm
KEYWORDS Acute gastrointestinal bleeding; Interventional Imaging; Arterial embolization
Gastrointestinal bleeding is classically defined according to the location of its cause. Accordingly, upper gastrointestinal bleeding originates from a cause located between the oral cavity and the angle of Treitz whereas lower gastrointestinal bleeding arises from the segment between the angle of Treitz and the anus [1]. Recently, it has been suggested to classify gastrointestinal bleedings into three categories: upper, middle and lower, with the middle one originating from the small bowel only [2]. Mortality from acute overt gastrointestinal bleeding (AOGIB) has been estimated to 10% and dramatically rises up to 21—40% in patients with massive AOGIB [3—5]. Consequently, prompt diagnosis of AOGIB and identification of the cause and location is mandatory to avoid delay in appropriate management. Several studies have investigated the performances of computed tomography (CT) in the diagnosis of gastrointestinal bleeding [6—11]. CT is used as the first line diagnostic modality at many institutions in patients with acute overt gastrointestinal bleeding [12—16] although guidelines from gastrointestinal societies still consider that endoscopy should be performed first [17,18]. In the same time, appropriate management of acute gastrointestinal bleeding has been subjected to dramatic changes. Surgery has been considered as the reference treatment for many years [19], but percutaneous arterial embolization, when possible, is now considered as the first line treatment at many facilities, even in hemodynamically instable patients [20]. CT can depict active contrast extravasation in patients with life-threatening AOGIB. Diagnostic performance has been improved by the use of multiplanar and maximum intensity projection (MIP) reformations from submillimeter isotropic voxels [12]. In a metaanalysis, Garcia-Blazquez et al., found an overall sensitivity of CT angiography for depicting active gastrointestinal bleeding of 85.2% (95% CI 75.5% to 91.5%) and a specificity of 92.1% (95% CI 76.7% to 97.7%) [6]. Marti et al. reported a correct identification of the causative lesion in 39/47 patients (83%) [7]. It is now well established that CT is superior to nuclear red blood cell scan for the evaluation of lower gastrointestinal bleeding [17]. CT decreases scanning time, allows accurate acquisition of CT images obtained during the arterial time and demonstrates contrast material extravasation into any portion of the gastrointestinal tract. CT has therefore replaced the nuclear red blood cell scan in many centers [17].
http://dx.doi.org/10.1016/j.diii.2017.05.005 2211-5684/© 2017 Published by Elsevier Masson SAS on behalf of Editions franc ¸aises de radiologie.
2 Percutaneous arterial embolization is a well-established technique for the treatment of acute bleeding in a variety of locations [21—24]. More specifically, percutaneous arterial embolization has demonstrated clinical efficacy ranging from 71% to 100% in the management of acute lower gastrointestinal bleeding [25,26]. The technical success ranges between 73% and 100% depending on the presence of arterial vasospasm, atheromatous lesions, vessel tortuosity on the bleeding arteries [25,26]. In embolized patients, immediate hemostasis is achieved in 95% of them [25]. The rate of recurrence may reach up to 21% [25,26], the site of recurrence can be either the embolization site in 45%, a distinct site in 16% or an undetectable site in 39% of patients [25]. In this issue of Diagnostic & Interventional Imaging, BuaNgam et al. have reported the results of a study that was aimed at assessing the safety and efficacy of percutaneous arterial embolization in the treatment of acute lower gastrointestinal bleeding (LGIB) and to determine the potential factors that influence treatment outcome [27]. Thirty-eight patients with acute LGIB who were treated by percutaneous arterial embolization were retrospectively included [27]. Technical success of percutaneous arterial embolization was obtained in 35/38 patients (92%) whereas technical failure was observed in 3/38 patients (8%). Technical failure was due to vessel tortuosity and vasospasm [27]. The clinical success rate following percutaneous arterial embolization was 63% [27]. Of interest, among the 10 patients with clinical failure, 9 received gelatin sponge as embolic material, thus questioning the use of this embolic agent in acute LGIB by comparison with glue and metallic coils [28,29]. In the study by Bua-Ngam et al., bowel ischemia following percutaneous arterial embolization occurred in 5/38 patients (13%); mild ischemia without sequelae was observed in three patients and severe ischemia with bowel perforation requiring surgery in two patients [27]. These results are consistent with those of prior studies [30—32]. Of interest, Bua-Ngam et al. used gelatin sponge in 4 out 5 patients with ischemic complications. In their study, Bua-Ngam et al. did not identify variables that were significantly predictive for a failed percutaneous arterial embolization, although a trend toward an association was found between technical failure of percutaneous arterial embolization and comorbidities (OR, 0.12) and international normalized ratio > 1.3 (OR, 7.04) and a trend toward an association between clinical failure of percutaneous arterial embolization and hypovolemic shock (OR, 5.00) [27]. The study by Bua-Ngam et al., reinforces the general assumption that percutaneous arterial embolization has a high efficacy in the treatment of acute LGIB with an acceptable rate of complications. However, several questions remain unanswered, especially regarding the best embolic agent in this situation and the identification of predictive variables of failed percutaneous arterial embolization. These important questions should stimulate further prospective, multicenter and large-scale studies.
Disclosure of interest The authors declare that they have no competing interest.
Editorial
References [1] Ramaswamy RS, Choi HW, Mouser HC, Narsinh KH, McCammack KC, Treesit T, et al. Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol 2014;6:82—92. [2] Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009;6:637—46. [3] Sanders DS, Perry MJ, Jones SG, McFarlane E, Johnson AG, Gleeson DC, et al. Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. Eur J Gastroenterol Hepatol 2004;16:487—94. [4] van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494—9. [5] Hreinsson JP, Kalaitzakis E, Gudmundsson S, Bjornsson ES. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol 2013;48:439—47. [6] Garcia-Blazquez V, Vicente-Bartulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013;23:1181—90. [7] Marti M, Artigas JM, Garzon G, Alvarez-Sala R, Soto JA. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology 2012;262:109—16. [8] Yamaguchi T, Yoshikawa K, Enhanced CT. for initial localization of active lower gastrointestinal bleeding. Abdom Imaging 2003;28:634—6. [9] Stuber T, Hoffmann MH, Stuber G, Klass O, Feuerlein S, Aschoff AJ. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT. Abdom Imaging 2009;34:476—82. [10] Yoon W, Jeong YY, Kim JK. Acute gastrointestinal bleeding: contrast-enhanced MDCT. Abdom Imaging 2006;31:1—8. [11] Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 2006;239:160—7. [12] Duchat F, Soyer P, Boudiaf M, Martin-Grivaud S, Fargeaudou Y, Malzy P, et al. Multi-detector row CT of patients with acute intestinal bleeding: a new perspective using multiplanar and MIP reformations from submillimeter isotropic voxels. Abdom Imaging 2010;35:296—305. [13] Dohan A, Dautry R, Guerrache Y, Fargeaudou Y, Boudiaf M, Le Dref O, et al. Three-dimensional MDCT angiography of splanchnic arteries: pearls and pitfalls. Diagn Interv Imaging 2015;96:187—200. [14] Dohan A, Eveno C, Guerrache Y, Dautry R, Soyer P. Aortojejunal fistula causing obscure massive gastrointestinal bleeding: repeated CT is the key. Diagn Interv Imaging 2015;96:97—8. [15] Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics 2007;27:1055—70. [16] Kim JW, Shin SS, Yoon W, Chang NK, Heo SH, Jeong YY, et al. Diagnosis of acute gastrointestinal bleeding: comparison of the arterial, the portal, and the combined set using 64-section computed tomography. J Comput Assist Tomogr 2011;35:206—11. [17] Standards of Practice ASGE, Committee, Pasha SF, Shergill A, Acosta RD, Chandrasekhara V, Chathadi KV, Early D, et al. The
Editorial
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014;79:875—85. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015;110:1265—87. Schuetz A, Jauch KW. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbecks Arch Surg 2001;386:17—25. Dohan A, Eveno C, Dautry R, Guerrache Y, Camus M, Boudiaf M, et al. Role and effectiveness of percutaneous arterial embolization in hemodynamically unstable patients with ruptured splanchnic artery pseudoaneurysms. Cardiovasc Intervent Radiol 2015;38:862—70. Pelage JP, Le Dref O, Jacob D, Soyer P, Rossignol M, Truc J, et al. Uterine artery embolization: anatomical and technical considerations, indications, results, and complications. J Radiol 2000;81:1863—72. Gaudon C, Soussan J, Louis G, Moutardier V, Gregoire E, Vidal V. Late postpancreatectomy hemorrhage: predictive factors of morbidity and mortality after percutaneous endovascular treatment. Diagn Interv Imaging 2016;97:1071—7. Korkmaz M, ¸ Sanal B, Aras B, Bozkaya H, C ¸ ınar C, Güneyli S, et al. The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria. Diagn Interv Imaging 2016;97:197—201. Zandrino F, Tettoni SM, Gallesio I, Summa M. Emergency arterial embolization of upper gastrointestinal and jejunal tumors: an analysis of 12 patients with severe bleeding. Diagn Interv Imaging 2017;98:51—6. Weldon DT, Burke SJ, Sun S, Mimura H, Golzarian J. Interventional management of lower gastrointestinal bleeding. Eur Radiol 2008;18:857—67. Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009;104:2042—6. Bua-Ngam C, Norasetsingh J, Treesit T, Wedsart B, Chansanti O, Tapaneeyakorn J, et al. Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding:
3
[28]
[29]
[30]
[31]
[32]
a single-center experience. Diagn Interv Imaging 2017, http://dx.doi.org/10.1016/j.diii.2017.02.005. Yonemitsu T, Kawai N, Sato M, Tanihata H, Takasaka I, Nakai M, Minamiguchi H, Sahara S, Iwasaki Y, Shima Y, Shinozaki M, Naka T, Shinozaki M. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 2009;20: 1176—87. ® ® ® Loffroy R. Glubran2 , Histoacryl or Trufill : which cyanoacrylate glue for endovascular use? Diagn Interv Imaging 2016;97:119. Kwak HS, Han YM, Lee ST. The clinical outcomes of transcatheter microcoil embolization in patients with active lower gastrointestinal bleeding in the small bowel. Korean J Radiol 2009;10:391—7. Hur S, Jae HJ, Lee M, Kim HC, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol 2014;25:10—9. Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2003;14:1503—9.
P. Soyer (MD, PhD) a,∗ , A. Fohlen (MD) b , A. Dohan (MD, PhD) c a
Université Diderot-Paris-7, AP — HP, Paris, France b Department of diagnostic imaging and interventional radiology, centre hospitalier universitaire de Caen, Caen, France c Department of diagnostic radiology, royal victoria hospital, McGill university health centre, Montreal, QC, Canada ∗ Corresponding
author.
E-mail address: [email protected] (P. Soyer)