Abstracts
1998 Digestive Disease Week

#3583

ROLE OF ANGIOGRAPHY AND EMBOLIZATION FOR ACUTE MASSIVE UPPER GASTROINTESTINAL HEMORRHAGE. R. M. Walsh, P. Anain, M. Geisinger, D. Vogt, J. Mayes, S. Grundfest-Broniatowski and J.M. Henderson. Department of General Surgery and Radiology, Cleveland Clinic Foundation, Cleveland, Ohio.

The role of mesenteric angiography and embolization for acute, massive upper gastrointestinal (UGI) bleeding for poor surgical risk patients is unclear. A retrospective review was conducted for all patients that underwent angiography for nonmalignant and nonvariceal, gastric or duodenal hemorrhage that was documented, but not controlled by endoscopy. Thirty-one patients underwent angiography for acute UGI bleeding over a five year period ending in March, 1996. Twenty-seven patients required intensive care unit treatment (mean 17 days) with an mean APACHE III score of 87 (39% predicted hospital mortality), and 12 had multisystem organ failure. A mean of 1.7 endoscopies were performed to document acute gastric bleeding in 9(29%) or duodenal bleeding in 22(71%). An average of 19 units of PRBC's were transfused per patient. Eleven patients (35%) were found to have active bleeding by angiography. All of these had selective embolization, and an additional 13 patients underwent empiric embolization. Seven patients (22%) were cured by angiographic embolization as defined by _ 4 units PRBC transfused post angiography and no surgical intervention. Multiple variables were compared between those patients that were successfully treated by angiography and those that failed. There was a significantly higher amount of total blood transfused (27.42 vs 10.57 units, p<.008) and blood transfused post-angio (12.79 vs 2.43, p<.005) and a marginally significant increase in time to angio (5.29 vs 1.5 days, p<.08) in those patients who failed angiography. No differences were found due to gastric vs duodenal source, number comorbid diseases, APACHE score, or whether a specific bleed source was found by angiography. A total of 13 patients (42%) died, including seven of 13 patients who were operated for ongoing bleeding post-angiography. In conclusion, angiography with embolization for patient with massive UGI bleeding has limited utility and if considered should be performed early in their management.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.