Identifying Predictors of Early Rebleeding Following Transcatheter Embolization in Acute Non-Variceal Upper Gastrointestinal Bleeding: A Retrospective Analysis

Öz

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a critical medical emergency. While transcatheter arterial embolization (TACE) is increasingly utilized when endoscopic hemostasis fails, the risk factors for early rebleeding post-TACE remain unclear. This study aimed to identify predictors of early rebleeding within 30 days of TACE in refractory ANVUGIB cases. A retrospective analysis was conducted on 56 TACE procedures performed between June 2020 and June 2023. Patients were included based on strict criteria, including failed endoscopic hemostasis or unsuitability for endoscopy. We assessed variables associated with early rebleeding and conducted univariate and multivariate analyses to identify significant predictors. Despite a technical success rate of 100%, 39.3% of patients experienced early rebleeding. Significant predictors of rebleeding included delayed angiography (P = 0.023), comorbidities (P = 0.048), failed endoscopic hemostasis (P = 0.010), and embolization of multiple vascular territories (P = 0.012). Timely angiographic embolization is essential for effective bleeding control in ANVUGIB. Delayed angiography, presence of comorbidities, failed endoscopic hemostasis, and embolization of multiple vascular territories were identified as significant predictors of early rebleeding. These findings highlight the importance of early and targeted intervention to improve clinical outcomes.

Anahtar Kelimeler

• Upper gastrointestinal hemorrhage
• Endoscopy
• Angiography
• Embolization

Akut Varis Dışı Üst Gastrointestinal Kanamada Transkateter Embolizasyonun Ardından Erken Tekrar Kanamanın Öngördürücülerinin Belirlenmesi: Retrospektif Bir Analiz

Öz

Akut varis dışı üst gastrointestinal kanama (AVDÜGK), ciddi bir tıbbi acildir. Endoskopik hemostazın başarısız olduğu durumlarda transkateter arteriyel embolizasyon (TAKE) giderek daha fazla kullanılmakla birlikte, TAKE sonrası erken yeniden kanama risk faktörleri net değildir. Bu çalışma, dirençli AVDÜGK vakalarında TAKE’den sonraki 30 gün içinde erken yeniden kanama belirleyicilerini tespit etmeyi amaçlamıştır. Haziran 2020 ile Haziran 2023 arasında gerçekleştirilen 56 TAKE prosedürü üzerinde retrospektif bir analiz yapıldı. Hastalar, başarısız endoskopik hemostaz veya endoskopiye uygun olmama gibi katı kriterler doğrultusunda çalışmaya dahil edildi. Erken yeniden kanama ile ilişkili değişkenler değerlendirildi ve anlamlı belirleyicileri belirlemek için tek değişkenli ve çok değişkenli analizler yapıldı. Teknik başarı oranı %100 olmasına rağmen, hastaların %39,3’ünde erken yeniden kanama gözlendi. Yeniden kanamanın anlamlı belirleyicileri arasında gecikmiş anjiyografi (P = 0.023), eşlik eden hastalıklar (P = 0.048), başarısız endoskopik hemostaz (P = 0.010) ve birden fazla damar bölgesinin embolizasyonu (P = 0.012) yer almaktaydı. Bu bulgular, erken ve hedefe yönelik müdahalenin yeniden kanama riskini azaltmada önemli olduğunu göstermektedir. AVDÜGK’de başarılı kanama kontrolü için zamanında yapılan anjiyografik embolizasyon esastır. Gecikmiş anjiyografi, komorbiditeler, başarısız endoskopik hemostaz ve birden fazla damar bölgesine yapılan embolizasyon, erken yeniden kanama için anlamlı risk faktörleri olarak belirlenmiştir. Bu risk faktörleri, hasta sonuçlarını iyileştirmek amacıyla klinik karar süreçlerinde rehber olarak kullanılmalıdır.

Anahtar Kelimeler

• Üst gastrointestinal kanama
• Endoskopi
• Anjiyografi
• Embolizasyon

Kaynakça

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