P217 Effectiveness and safety of trans-arterial embolization for GI bleeding refractory to therapeutic endoscopy – a 10-year study
Bibliographic record
Abstract
<h3>Introduction</h3> Acute upper gastrointestinal bleeding (UGIB) is a common clinical scenario with significant mortality and morbidity. Endoscopic therapy remains the primary option, but lack of control or early rebleeding occurs in 7–16%. With evolution of interventional radiology (IR) and techniques such as microcatheters and new embolic agents, transarterial embolization (TAE) has emerged as second line treatment for uncontrolled UGIB. We evaluated clinical indications, technical success, complications, rebleeding and mortality following TAE in UGIB where endotherapy failed or was not feasible. <h3>Methods</h3> Retrospective analysis of patients presenting with UGIB and requiring TAE over 10 years in a tertiary centre. UGIB was defined as clinically significant, acute blood loss from a gastrointestinal source diagnosed by endoscopy and/or CT scan. Demographic, clinical and procedural data were collected from electronic medical records. <h3>Results</h3> 78 patients required TAE over the 10-year period. Demographic data is shown in table 1. 49 patients had an endoscopy pre-TAE where active bleeding was visualised in 45. Median red blood cell transfusion was 5 units. Major target for TAE was gastroduodenal artery (n=51) and other targets included superior mesenteric (n=10), inferior mesenteric (n=5), right gastric (n=2), left gastric (n=1), splenic (n=3), right hepatic (n=2), left hepatic (n=1) and gastroepiploic (n=3) arteries. Technical success was 100%. 17 patients rebled (22%), with 5 undergoing surgery, 6 patients being successfully re-treated with endotherapy and 4 patients being referred for repeat TAE. 2 patients were treated conservatively. 46 patients (59%) required high dependency or intensive care admission with the median length of admission of 4 days. The median length of hospital stay was 14 days. Survival during admission was 67% (n=52). Intraprocedural complications were seen in 6% (n=5) and included non-target embolization and coil migration. Post procedure complications included bowel ischaemia in 2 patients, haematoma at puncture site in 4 and acute kidney injury in 11 patients. Bowel ischaemia resolved spontaneously. <h3>Conclusions</h3> Management of UGIB refractory to endotherapy remains a challenge and requires a multi-disciplinary approach by endoscopists, interventional radiologists, surgeons and intensivists. Mortality is high (33%) in this group. There have been significant advances in interventional radiology techniques and devices and TAE is a safe and effective therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".