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Title: | Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome | Authors: | Maleux, Geert Bielen, Jurgen LAENEN, Annouschka Heye, Sam Vaninbroukx, Johan Laleman, Wim Verhamme, Peter Wilmer, Alexander Van Steenbergen, Werner |
Issue Date: | 2014 | Publisher: | SPRINGER | Source: | EUROPEAN RADIOLOGY, 24 (11), p. 2779-2786 | Abstract: | To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality. From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected. Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012). Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival. aEuro cent Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding aEuro cent The rate of rebleeding is acceptably low aEuro cent Haemostatic disorders appear to significantly influence 30-day survival. | Notes: | [Maleux, Geert; Bielen, Jurgen; Heye, Sam; Vaninbroukx, Johan] Univ Hosp Leuven, Dept Radiol, B-3000 Leuven, Belgium. [Maleux, Geert; Bielen, Jurgen; Heye, Sam; Vaninbroukx, Johan] Katholieke Univ Leuven, Dept Imaging & Pathol, Leuven, Belgium. [Laenen, Annouschka] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, Leuven, Belgium. [Laenen, Annouschka] Univ Hasselt, Hasselt, Belgium. [Laleman, Wim; Van Steenbergen, Werner] Univ Hosp Leuven, Dept Hepatol, B-3000 Leuven, Belgium. [Verhamme, Peter] Univ Hosp Leuven, Dept Vasc Med, B-3000 Leuven, Belgium. [Wilmer, Alexander] Univ Hosp Leuven, Dept Intens Care Med, B-3000 Leuven, Belgium. | Keywords: | Embolization; Haemorrhage; Gastrointestinal tract; Endoscopy; Iatrogenic;embolization; haemorrhage; gastrointestinal tract; endoscopy; iatrogenic | Document URI: | http://hdl.handle.net/1942/18767 | ISSN: | 0938-7994 | e-ISSN: | 1432-1084 | DOI: | 10.1007/s00330-014-3332-5 | ISI #: | 000343140100013 | Rights: | © European Society of Radiology 2014 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2015 |
Appears in Collections: | Research publications |
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