International Journal of Gastrointestinal Intervention · Published 2025-06-25 · DOI 10.18528/ijgii240079
Background : Acute lower gastrointestinal bleeding (LGIB) is a major cause of morbidity and mortality, especially in older adults. This study evaluates the safety and outcomes of endoscopic clip-guided transcatheter arterial embolization (TAE) in angiography-negative LGIB cases refractory to endoscopic treatment. Methods : This retrospective study included patients with acute LGIB unresponsive to endoscopic hemostasis who subsequently underwent angiography. Patients with angiographically negative findings and endoscopic clips placed at the suspected bleeding site were considered for superselective embolization guided by the clips. Embolization was performed using Gelfoam particles, with microcoils or autologous blood clots used in select cases. Patients were monitored for rebleeding, ischemic complications, and embolization-related adverse events. Results : Among 20 patients who underwent angiography for LGIB, 13 had negative angiographic findings. Of these, 11 patients underwent superselective embolization guided by endoscopic clips. The most common cause of LGIB was colonic diverticulosis (63%), with the ascending colon being the most frequent bleeding site. Technical success was achieved in all cases (100%), and clinical success was observed in 73% (8/11). Three patients experienced rebleeding within 24 hours; one underwent repeat TAE, while two required segmental resection. No major complications were reported, and minor complications such as abdominal pain, nausea, and vomiting were managed conservatively. The mean follow-up period was 5.8 months (range, 1.6-13.8 months).Conclusions : Endoscopic clip-guided TAE is a safe and feasible option for managing angiography-negative LGIB after failed endoscopic treatment.
Abstract from DOAJ. Public domain (CC0 1.0).
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