Zain M Khazi, Jasraj Marjara, Michael Nance, Yezaz Ghouri, Ghassan Hammoud, Ryan Davis, Ambarish Bhat
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Demographics, comorbidities, endoscopic and angiographic findings, significant post-embolization pRBC transfusion, and index GDAE failure were collected. Failure of index GDAE was defined as the need for re-intervention (repeat embolization, endoscopy, or surgery) for rebleeding or mortality within 30 days after GDAE. Multivariate analyzes were performed to identify independent predictors for failure of index GDAE.</p><p><strong>Results: </strong>There were 70 patients that underwent GDAE after endoscopic intervention for bleeding peptic ulcers with a technical success rate of 100%. Failure of index GDAE rate was 23% (<i>n</i> = 16). Multivariate analysis identified ≥2 comorbidities (odds ratio [OR]: 14.2 [1.68-19.2], <i>P</i> = 0.023), days between endoscopy and GDAE (OR: 1.43 [1.11-2.27], <i>P</i> = 0.028), and extravasation during angiography (OR: 6.71 [1.16-47.4], <i>P</i> = 0.039) as independent predictors of index GDAE failure. Endoscopic Forrest classification was not a significant predictor for the failure of index GDAE (<i>P</i> > 0.1).</p><p><strong>Conclusion: </strong>The study demonstrates safety and efficacy of GDAE for hemorrhage from PUD that is refractory to endoscopic intervention. Days between endoscopy and GDAE, high comorbidity burden, and extravasation during angiography are associated with increased risk for failure of index GDAE.</p>","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/4a/JCIS-12-31.PMC9235422.pdf","citationCount":"2","resultStr":"{\"title\":\"Gastroduodenal artery embolization for peptic ulcer hemorrhage refractory to endoscopic intervention: A single-center experience.\",\"authors\":\"Zain M Khazi, Jasraj Marjara, Michael Nance, Yezaz Ghouri, Ghassan Hammoud, Ryan Davis, Ambarish Bhat\",\"doi\":\"10.25259/JCIS_45_2022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the efficacy of gastroduodenal artery embolization (GDAE) for bleeding peptic ulcers that failed endoscopic intervention. To identify incidence and risk factors for failure of GDAE.</p><p><strong>Materials and methods: </strong>A retrospective review of patients who underwent GDAE for hemorrhage from peptic ulcer disease refractory to endoscopic intervention were included in the study. Refractory to endoscopic intervention was defined as persistent hemorrhage following at least two separate endoscopic sessions with two different endoscopic techniques (thermal, injection, or mechanical) or one endoscopic session with the use of two different techniques. Demographics, comorbidities, endoscopic and angiographic findings, significant post-embolization pRBC transfusion, and index GDAE failure were collected. Failure of index GDAE was defined as the need for re-intervention (repeat embolization, endoscopy, or surgery) for rebleeding or mortality within 30 days after GDAE. Multivariate analyzes were performed to identify independent predictors for failure of index GDAE.</p><p><strong>Results: </strong>There were 70 patients that underwent GDAE after endoscopic intervention for bleeding peptic ulcers with a technical success rate of 100%. Failure of index GDAE rate was 23% (<i>n</i> = 16). Multivariate analysis identified ≥2 comorbidities (odds ratio [OR]: 14.2 [1.68-19.2], <i>P</i> = 0.023), days between endoscopy and GDAE (OR: 1.43 [1.11-2.27], <i>P</i> = 0.028), and extravasation during angiography (OR: 6.71 [1.16-47.4], <i>P</i> = 0.039) as independent predictors of index GDAE failure. Endoscopic Forrest classification was not a significant predictor for the failure of index GDAE (<i>P</i> > 0.1).</p><p><strong>Conclusion: </strong>The study demonstrates safety and efficacy of GDAE for hemorrhage from PUD that is refractory to endoscopic intervention. Days between endoscopy and GDAE, high comorbidity burden, and extravasation during angiography are associated with increased risk for failure of index GDAE.</p>\",\"PeriodicalId\":15512,\"journal\":{\"name\":\"Journal of Clinical Imaging Science\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2022-06-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/4a/JCIS-12-31.PMC9235422.pdf\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Imaging Science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25259/JCIS_45_2022\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Imaging Science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/JCIS_45_2022","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 2
摘要
目的:探讨胃十二指肠动脉栓塞术(GDAE)治疗内镜干预失败的消化性溃疡出血的疗效。确定GDAE失败的发生率和危险因素。材料和方法:回顾性分析内镜干预难治性消化性溃疡出血行GDAE治疗的患者。内镜干预难治性定义为:至少两次使用两种不同的内镜技术(热、注射或机械)或一次使用两种不同的内镜技术后持续出血。统计数据、合并症、内窥镜和血管造影结果、栓塞后显著的pRBC输血和GDAE指数失败。指数GDAE失败的定义为在GDAE后30天内再次出血或死亡需要再次干预(重复栓塞、内镜检查或手术)。进行多变量分析以确定指数GDAE失败的独立预测因子。结果:70例消化性溃疡出血患者经内镜干预后行GDAE，技术成功率100%。指标GDAE失败率为23% (n = 16)。多因素分析发现，≥2个合并症(比值比[OR]: 14.2 [1.68-19.2]， P = 0.023)、内镜检查与GDAE间隔天数(OR: 1.43 [1.11-2.27]， P = 0.028)和血管造影期间外渗(OR: 6.71 [1.16-47.4]， P = 0.039)是GDAE失败指数的独立预测因素。内窥镜Forrest分类不是GDAE指数失败的显著预测因子(P > 0.1)。结论:本研究证明了GDAE治疗难治性PUD出血的安全性和有效性。内镜检查和GDAE之间的间隔天数、高合并症负担和血管造影期间的外渗与GDAE指数失败的风险增加有关。
Gastroduodenal artery embolization for peptic ulcer hemorrhage refractory to endoscopic intervention: A single-center experience.
Objective: To determine the efficacy of gastroduodenal artery embolization (GDAE) for bleeding peptic ulcers that failed endoscopic intervention. To identify incidence and risk factors for failure of GDAE.
Materials and methods: A retrospective review of patients who underwent GDAE for hemorrhage from peptic ulcer disease refractory to endoscopic intervention were included in the study. Refractory to endoscopic intervention was defined as persistent hemorrhage following at least two separate endoscopic sessions with two different endoscopic techniques (thermal, injection, or mechanical) or one endoscopic session with the use of two different techniques. Demographics, comorbidities, endoscopic and angiographic findings, significant post-embolization pRBC transfusion, and index GDAE failure were collected. Failure of index GDAE was defined as the need for re-intervention (repeat embolization, endoscopy, or surgery) for rebleeding or mortality within 30 days after GDAE. Multivariate analyzes were performed to identify independent predictors for failure of index GDAE.
Results: There were 70 patients that underwent GDAE after endoscopic intervention for bleeding peptic ulcers with a technical success rate of 100%. Failure of index GDAE rate was 23% (n = 16). Multivariate analysis identified ≥2 comorbidities (odds ratio [OR]: 14.2 [1.68-19.2], P = 0.023), days between endoscopy and GDAE (OR: 1.43 [1.11-2.27], P = 0.028), and extravasation during angiography (OR: 6.71 [1.16-47.4], P = 0.039) as independent predictors of index GDAE failure. Endoscopic Forrest classification was not a significant predictor for the failure of index GDAE (P > 0.1).
Conclusion: The study demonstrates safety and efficacy of GDAE for hemorrhage from PUD that is refractory to endoscopic intervention. Days between endoscopy and GDAE, high comorbidity burden, and extravasation during angiography are associated with increased risk for failure of index GDAE.
期刊介绍：
The Journal of Clinical Imaging Science (JCIS) is an open access peer-reviewed journal committed to publishing high-quality articles in the field of Imaging Science. The journal aims to present Imaging Science and relevant clinical information in an understandable and useful format. The journal is owned and published by the Scientific Scholar. Audience Our audience includes Radiologists, Researchers, Clinicians, medical professionals and students. Review process JCIS has a highly rigorous peer-review process that makes sure that manuscripts are scientifically accurate, relevant, novel and important. Authors disclose all conflicts, affiliations and financial associations such that the published content is not biased.
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