Early Experience Using Tantalum-Loaded Nanocomposite Hydrogel Conformable Embolic for Upper Gastrointestinal Bleeding-Open-Sandwich Technique

TL;DR

A new embolization technique using tantalum-loaded hydrogel and a single coil was tested for treating upper gastrointestinal bleeding, showing promising results in a small patient group.

Contribution

The novel 'open-sandwich' technique combines a single coil with tantalum-loaded hydrogel for embolization of gastroduodenal arteries in UGIB.

Findings

Technical success rate was 100% with no immediate procedural complications.

Clinical success was achieved in 80% of patients, with a mean hemoglobin increase of 1.47 g/dL observed.

Two patients required re-intervention due to incomplete embolization.

Abstract

Background/Objectives: To evaluate the efficacy and safety of using tantalum-loaded Obsidio conformable embolic (Ta-OCE) in gastroduodenal artery (GDA) embolization for upper gastrointestinal bleeding (UGIB), employing a novel “open-sandwich” technique. Methods: An institutional review board (IRB)-approved retrospective analysis was conducted on patients who underwent GDA embolization for UGIB using Ta-OCE between May 2023 and June 2024, using an “open-sandwich” technique. Briefly, the retrograde sources of flow, namely the right gastroepiploic artery (RGEA), was commonly embolized with a single, usually detachable, coil at its proximal aspect. Beginning within the proximal RGEA adjacent to the coil and distal to the site of extravasation and/or an endoscopically placed clip, Ta-OCE was then instilled in a continuous fashion to the origin of GDA. Technical success was defined as complete occlusion of the target vessel without immediate procedural complications. Clinical success was assessed as the absence of rebleeding within 4 weeks post-embolization. Adverse events were evaluated using Common Toxicity Criteria for Adverse Events (v.5). Results: Overall, a total of 10 patients, with a mean age of 67.3 years, underwent Ta-OCE embolization for UGIB. A technical success rate of 100% was achieved with no instances of immediate procedural complications. Clinical success was achieved in eight patients (80%). Re-intervention was required in two patients in whom the proximal GDA and distal GDA/proximal RGEA were not embolized adequately, respectively. A significant change in mean hemoglobin levels was observed 24 h pre- and post-embolization, with a mean increase of 1.47 g/dL. Conclusions: Despite the small sample size, lack of control group, and retrospective design, the “open-sandwich” technique combining Ta-OCE with a single coil appears to be an effective and safe method of GDA embolization in the setting of UGIB. Larger multicenter studies are needed to further evaluate the feasibility of this technique.

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