{"\ufeffTHE EFFECTIVENESS OF EMPIRIC TRANSARTERIAL GLUE EMBOLIZATION (TAGE) OF GASTRODUODENAL ARTERY (GDA) FOR BLEEDING DUODENAL ULCER: A RETROSPECTIVE STUDY\n\nW.S. Lee1*, H.J. Ong1, Z.W. Chua1, K.B. Loh1\n\n1Department of Radiology, Penang General Hospital, Jalan Residensi, 10990 Georgetown, Pulau Pinang, Malaysia\n\n*Corresponding author:  \nWil Sern Lee, Department of Radiology, Penang General Hospital, Jalan Residensi, 10990 Georgetown, Pulau Pinang, Malaysia. Email: leewilsern@gmail.com\n\nDOI: https://doi.org/10.32896/tij.v4n1.1-10\nSubmitted: 11.04.2024\nAccepted: 24.06.2024\nPublished: 30.06.2024\n \nABSTRACT: \nPurpose\nTo determine the efficacy of empiric transarterial glue embolization (TAGE) of gastroduodenal artery (GDA) for bleeding duodenal ulcers. \n\nMaterials and Methods\nAll patients treated for bleeding duodenal ulcers between June 2019 and June 2023, in a single tertiary centre (Penang General Hospital) were retrospectively identified based on interventional radiology reports. Patients with bleeding duodenal ulcers underwent empiric TAGE of GDA following endoscopic hemostasis were included. \n\nResults\nDuring the study period, a total of 26 patients had empiric TAGE of GDA for bleeding duodenal ulcer. A total of 25 patients with duodenal ulcers of Forrest Ia (n": null, " Miami, Florida) and Simmons Sim 1 (Cordis": null, " Miami, Florida)  catheters. Subsequently, the gastroduodenal artery was selectively cannulated with a 2.4F Renegade microcatheter from the common hepatic artery. Super-selective embolisation of branches supplying D1, D2 segments of duodenum was performed with N-butylcyanoacrylate (NBCA): Lipiodol mixture with ratio ranging from 1:2 to 1:4, with end point of achieving proximal occlusion of GDA.  Post embolisation GDA angiogram was performed to assess the adequacy of embolisation. \n\nRESULTS\nFollowing initial endoscopic haemostasis, 26 patients were planned for TAGE of GDA. Technical and clinical success rates of angiographically negative TAGE were 96.2% and 84%. One of the patients with technical failure was due to tortuous arterial anatomy as the normal anatomy was disrupted by prior surgical repair of perforated gastric ulcer. Recurrent bleeding occurred in four (16%) patients which required further endoscopic clipping. Out of the 25 patients, 7 died within the first-30 days giving a mortality rate of 28%. The causes of death were mostly unrelated to the procedure, which include multiorgan failure (n": null, "71:102958. Available from: https://www.sciencedirect.com/science/article/pii/S2049080121009080#tbl1\n    2. Hastings GS. Angiographic Localization and Transcatheter Treatment of Gastrointestinal Bleeding. 2000 Jul 1": null, "20(4):1160\u20138.\n    3. Lakhwani MN, Ismail AR, Barras CD, Tan WJ. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia. The Medical Journal of Malaysia [Internet]. 2000 Dec 1": null, "55(4):498\u2013505. Available from: https://pubmed.ncbi.nlm.nih.gov/11221164/ \n    4. Author: Malaysia. Kementerian Kesihatan, Academy Of Medicine Of Malaysia, And G. Management of non-variceal upper gastrointestinal bleeding. Editorial: Kuala Lumpur: Ministry Of Health Malaysia": null, " 2003.\n    5. de Groot NL, van Oijen MGH, Kessels K, Hemmink M, Weusten BLAM, Timmer R, et al. 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Journal of Vascular and Interventional Radiology. 2001 Feb 1": null, "12(2):195\u2013200.\nTABLE LEGENDS:\n\nTable 1: Demographics and clinical characteristics of study patients.\n\nSex\n\nMale\n17 (68%)\nFemale\n8 (32%)\nAge (mean) [range]\n66.12 [19-86] years\nComorbidities\n\nHypertension\n20 (80%)\nDiabetes mellitus\n13 (52%)\nDyslipidaemia\n8 (32%)\nMalignancy\n3 (12%)\nIschaemic heart disease\n4 (16%)\nLiver cirrhosis\n1 (4%)\nForrest classification\n\nIa\n5 (20%)\nIb\n12 (48%)\nIIa\n4 (16%)\nIIb\n3 (12%)\nIIc\n1 (4%)\nIII\n0 (0%)\nTable 2: Outcomes of patients post TAGE of GDA.\n\n\nTechnical success\n25/26 (96.2%)\nClinical outcomea\n\nRecurrent bleeding\n4 (16%)\nNo recurrent bleeding\n21 (84%)\nTotal 30-day mortality ratea\n7 (28%)\nMortality due to refractory bleed\n1 (4%)\nMortality due to other causes\n6 (24%)\nSurvival at 30-daya\n17 (68%)\n\naOnly includes patients with angiographically negative technical successful TAGE of GDA.\n\nTable 3: Number of patients with rebleeding after TAGE based on rebleeding risk (simplified Forrest classification)\n\nRebleeding Risk\nTotal number of patients, n (%)\nRebleeding Post TAGE of GDA, n (%)\nHigh\n5 (20%)\n1 (20%)\nIncreased\n20 (80%)\n3 (15%)\nLow\n0\n0\n\nFIGURE LEGENDS:\n\n\nFigure 1: Selective catheterization of GDA with microcatheter demonstrating segmental spasm of GDA (arrow) which is an indirect sign of recent bleeding.\n\n\n\n\n\n\nFigure 2: Post embolization angiogram demonstrates glue cast (arrow) and immediate obliteration of GDA.": null}