Treatment of acute lower gastrointestinal hemorrhage by superselective transcatheter embolization.

AIM: To evaluate the technical feasibility, success of hemostasis and complications of transcatheter embolization in the treatment of acute lower gastrointestinal (GI) bleeding. METHODS: Retrospective review of 63 patients with acute lower GI bleed who had undergone transcatheter selective embolization of mesenteric arteries over a two-year period. Embolization was carried out only if the arteria recta leading to the bleed could be successfully catheterized (n=52). The lesions treated were located in the jejunum (n=13), ileum and ileo-cecal region (n=9), appendicular region (n=2) and colon (n=28). Embolization was performed with only polyvinyl alcohol particles (PVA) (250-500 microns) in 23 patients, only microcoils in 16 patients and both PVA particles and microcoils in 13 patients. Twenty-eight patients were evaluated for objective evidence of ischemia by colonoscopy (n=21) and/or histologic evidence in the surgical specimen (n=7); 23 patients were followed up clinically. RESULTS: Immediate hemostasis was achieved in 61 of 63 patients; of the remaining 2 patients, one underwent surgery whereas the other died during the procedure. Recurrent bleeding occurred in 9 patients - 6 were managed surgically and 3 medically. Endoscopic evaluation showed mucosal ischemia in 7 patients but they remained asymptomatic on follow up. Embolization was the sole modality of treatment in 41 patients (78.9%). CONCLUSION: Transcatheter superselective embolization is an effective and safe modality of treatment for acute lower GI bleeding.

Transjugular liver biopsy--experience in fifty patients.

OBJECTIVE: We evaluated the safety, adequacy, clinical impact and cost of transjugular liver biopsies performed at our institution. METHODS: Eighty-four biopsies performed in 50 consecutive patients with coagulopathy (INR >1.4; n=20), thrombocytopenia (platelet count <75,000/cmm; n=17), ascites (n=10), or coagulopathy and thrombocytopenia (n=3) from April 1999 to July 2002 were analyzed. Biopsy was performed under local anesthesia with fluoroscopic guidance, using the Quick Core biopsy needle. RESULTS: Ninety-two needle passes were made to obtain 84 samples. Biopsy was technically unsuccessful in two patients because of hepatic vein ostial block; however, the procedure established the diagnosis of blockage of hepatic vein ostia in these patients. Biopsy specimen was adequate for histological examination in 45 patients. The median number of biopsies performed with 18- and 19-gauge needles was 14 and 8, respectively. The biopsy provided diagnostic information in 23 of 50 (46%) patients, and helped in staging or providing prognostic information in 37 (74%) patients. There were no major complications. Minor complications included transient hepatic vein-to-portal vein fistula in 2, transient hepatic vein-biliary fistula in one, local hematoma in 5, and post-procedure fever in 5 patients. The approximate cost of the needle and accessories was Rs. 2000 per patient. CONCLUSIONS: Transjugular liver biopsy was safe, provided adequate tissue in 90% of patients, and helped frequently in diagnosis and in staging or prognostication of disease.