Efficacy and clinical outcomes of angiography and transcatheter arterial embolization for gastrointestinal bleeding in Crohn's disease

Background: To retrospectively investigate the use of angiography as a diagnostic tool and evaluate technical and clinical efficacy of transcatheter arterial embolization (TAE) in Crohn's disease-related gastrointestinal (GI) bleeding. Methods: Institutional Review Board approval with waiver of patients' informed consent requirement was obtained. There were 39 angiographies performed in 24 patients (male:female = 18:6, median age = 25 years) presenting with Crohn's disease-related GI bleeding between 2001 and 2014. The technical and clinical success rate of TAE as well as procedure-related complications and 2-year mortality rate were evaluated. Clinical factors such as vital signs and laboratory findings as well as other modalities of investigations were analyzed. Results: Among 39 angiographies, 25.6% of angiographies were performed as the initial choice of investigation and angiography was performed after endoscopy failed to identify a bleeding site in 33.3%. There were negative angiographic findings in 66.7% (26/39). TAE (n = 13) demonstrated 100% technical success rate and 69.2% (9/13) clinical success rate with one case of ischemic complication and one case of mortality due to combined pneumonia. Ileal branches were the most frequent site of embolization and the combination of gelatin sponge slurry and microcoil was most commonly used. Conclusion: Angiography and TAE may be the initial or follow-up management option in patients with Crohn's disease presenting with acute GI bleeding. Although the rate of negative angiographic findings was high (66.7%), TAE showed high technical success rate and acceptable clinical success rate in patients with positive angiographic findings. Copyright (C) 2019, Society of Gastrointestinal Intervention.