Transcatheter arterial embolization for gastrointestinal bleeding related to pancreatic adenocarcinoma: clinical efficacy and predictors of clinical outcome

•A highly detected bleeding foci was effectively treated with TAE.•Stent-related bleeding was frequent and characteristic angiogram was arterial cut-off.•Massive transfusion and TNM stage 4 were related to clinical failure. To evaluate the clinical efficacy of transcatheter arterial embolization (TA...

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Published in:European journal of radiology 2020-02, Vol.123, p.108787-108787, Article 108787
Main Authors: Lee, Sang Min, Jeong, So Yeong, Shin, Ji Hoon, Choi, Ho Cheol, Na, Jae Boem, Won, Jung Ho, Park, Sung Eun, Chen, Cheng Shi
Format: Article
Language:English
Subjects:
Adenocarcinoma - complications
Adenocarcinoma - diagnostic imaging
Aged
Aged, 80 and over
Angiography - methods
Embolization, Therapeutic - methods
Endovascular embolization
Female
Gastrointestinal bleeding
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Humans
Male
Middle Aged
Pancreas - diagnostic imaging
Pancreatic cancer
Pancreatic Neoplasms
Pancreatic Neoplasms - complications
Pancreatic Neoplasms - diagnostic imaging
Retrospective Studies
Treatment Outcome
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Summary:•A highly detected bleeding foci was effectively treated with TAE.•Stent-related bleeding was frequent and characteristic angiogram was arterial cut-off.•Massive transfusion and TNM stage 4 were related to clinical failure. To evaluate the clinical efficacy of transcatheter arterial embolization (TAE) for managing pancreatic adenocarcinoma-related gastrointestinal (GI) bleeding, and to determine the factors associated with clinical outcomes. From 2001–2017, this retrospective study included 58 patients who underwent TAE for pancreatic adenocarcinoma-related GI bleeding. The technical and clinical success of TAE, clinical factors including patient characteristics and embolization details, complications, and the 30-day mortality were evaluated. Univariate analyses were performed to determine the factors related to the clinical outcomes. On angiography, bleeding foci were detected in 47 patients (81%), while the other 11 patients showed tumor staining. Technical success rate was 98%, and first session and overall clinical success rates were 79% and 88%, respectively. N-butyl cyanoacrylate (NBCA) was the most commonly used embolic agent (53%). Stent-related bleeding was shown in 22 patients with characteristic angiogram such as arterial cut-off (13/22) and arteriobiliary fistula (5/22), with comparable clinical success rate (82%). Bleeding from the superior mesenteric artery (n = 3) at the first session of angiography and complications (n = 2), such as ischemic hepatitis and small bowel infarction, were all associated with a 30-day mortality. The overall 30-day mortality rate was 22%. Univariate analysis showed that massive transfusion and TNM stage 4 were related to clinical failure (P = 0.035 and 0.038, respectively). TAE was effective and safe for pancreatic adenocarcinoma-related GI bleeding. Stent-related bleeding was not uncommon, and associated with vascular abnormality amenable to TAE. Massive transfusion and TNM stage 4 were related to clinical failure.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2019.108787