Transcatheter Arterial Embolization for Non-Variceal Upper Gastrointestinal Bleeding: Does the Number of Prior EGDs Matter?

Abstract

Background and Aims: Transcatheter arterial embolization (TAE) is an important therapy for non-variceal upper gastrointestinal bleeding (NVUGIB) when endoscopic intervention fails. The impact of repeated esophagogastroduodenoscopies (EGDs) before TAE on clinical outcomes remains unclear. This study aimed to evaluate the association between the number of EGDs before TAE and outcomes including rebleeding, mortality, and hospitalization. Methods: We conducted a retrospective cohort study of adults with NVUGIB undergoing TAE at a single tertiary center (2010–2023). Patients were stratified by the number of pre-TAE EGDs (0, 1, and ≥ 2), embolization strategy (therapeutic, empiric, no embolization), number of embolic agents, and vessel involvement. Primary outcome was 30-day rebleeding; secondary outcomes included in-hospital and 30-day mortality, length of stay, transfusion needs, and cost. Results: Ninety-two patients (median age 68; 52.2% male) were included. Thirty-day rebleeding occurred in 43.3%, and in-hospital mortality was 14.1%. Patients with ≥ 2 EGDs had the longest hospital stay (14.5 vs. 10 vs. 5.5 days; p = 0.0027) without reduced rebleeding or mortality. Rebleeding was highest with no embolization (81.8%) versus empiric (35.8%) or therapeutic (42.3%) embolization (p = 0.017). Repeated EGDs were associated with lower embolization rates, while triple embolic agents correlated with highest mortality (66.7%; p = 0.0152). Conclusions: Repeated EGDs before TAE prolonged hospitalization without improving outcomes. Both empiric and therapeutic embolization reduced rebleeding compared with angiography alone. Early referral for TAE after failed endoscopy may optimize NVUGIB management.