2- Using Glubran 2 glue to maximize results of arterial embolization

LETTER TO THE EDITOR:

We read with great interest the article by Lee et al. published recently in the Scandinavian Journal of Gastroenterology and evaluating the role of transcatheter arterial embolization (TAE) for endoscopically unmanageable non-variceal upper gastrointestinal (UGI) bleeding. We have several comments. First of all, we would like to congratulate the authors for their paper, which represents one of the main studies to date reporting the factors predicting embolization failure after TAE in patients with UGI bleeding. Among the 66 patients, it seems that TAE was performed in 59 patients, either based on the findings of angiography (51 patients) or based on endoscopic findings in the absence of angiographic abnormality (8 patients).
What about the seven remaining patients for whom no data are available in the article? Furthermore, despite the technically successful embolization, the rebleeding rate within 30 days was relatively high at 46.6%. According to the authors, one of possible explanations for such high rebleeding rate after TAE is that there was a high proportion of malignant bleeding in the included cases. One other explanation might be the influence of the type of embolic agent used. Indeed, in around 40% of patients, only one embolic agent was used for TAE……

TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25–15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43–17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization.