Objectives Although various embolic agents are used for transcatheter arterial embolization (TAE) of colonic diverticular bleeding (CDB), comparative outcome data for different embolic agents are limited. We aimed to assess the association between embolic agent choice and early rebleeding and intestinal ischemia after TAE for CDB. Materials and methods We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between July 2010 and March 2022. Adults who underwent a first TAE for CDB with coils, gelatin sponge (GS) particles, or n‑butyl‑2‑cyanoacrylate (NBCA) were included. Multivariate logistic regression analyses were performed to evaluate the association of embolic agent choice with early rebleeding requiring intervention and intestinal ischemic complications, while adjusting for covariates and within-hospital clustering. Results The cohort comprised 5625 patients (mean age 72 years ± 12 [standard deviation], 4020 men). Coils, GS particles, and NBCA were used in 59%, 30%, and 11%, respectively. The overall early incidence of rebleeding and intestinal ischemia was 12% and 1.0%, respectively. With coils as the reference, the adjusted odds ratio for GS particles was 1.38 (95% CI: 1.15–1.66; p = 0.001) for early rebleeding and 2.64 (95% CI: 1.43–4.90; p = 0.002) for intestinal ischemia, and those for NBCA were 0.69 (95% CI: 0.50–0.95; p = 0.03) for early rebleeding and 3.53 (95% CI: 1.72–7.22; p = 0.001) for intestinal ischemia. Conclusions Compared with coils, GS particles were associated with an increase in both early rebleeding and intestinal ischemia, whereas NBCA was associated with decreased rebleeding and increased ischemia. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Transcatheter arterial embolization (TAE) is one of the mainstay treatments for colonic diverticular bleeding, but outcome differences among embolic agents remain unclear. <Emphasis Type="BoldItalic">Findings</Emphasis> Gelatin sponge particles increased both early rebleeding and intestinal ischemic risks, while coils reduced intestinal ischemic risk and n‑butyl‑2‑cyanoacrylate reduced early rebleeding risk. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Embolic material selection should be individualized for TAE in colonic diverticular bleeding. Coils may be safer in ischemia-prone patients, while n‑butyl‑2‑cyanoacrylate may be suitable for those at high risk of rebleeding. Graphical Abstract

Association between embolic agent choice and complications after transcatheter arterial embolization for colonic diverticular bleeding

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2025年12月19日

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Takatoshi Kubo,
Hayato Yamana,
Shotaro Aso,
Hiroki Matsui,
Kiyohide Fushimi,
Hideo Yasunaga,
Osamu Abe

摘要

Objectives

Although various embolic agents are used for transcatheter arterial embolization (TAE) of colonic diverticular bleeding (CDB), comparative outcome data for different embolic agents are limited. We aimed to assess the association between embolic agent choice and early rebleeding and intestinal ischemia after TAE for CDB.

Materials and methods

We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between July 2010 and March 2022. Adults who underwent a first TAE for CDB with coils, gelatin sponge (GS) particles, or n‑butyl‑2‑cyanoacrylate (NBCA) were included. Multivariate logistic regression analyses were performed to evaluate the association of embolic agent choice with early rebleeding requiring intervention and intestinal ischemic complications, while adjusting for covariates and within-hospital clustering.

Results

The cohort comprised 5625 patients (mean age 72 years ± 12 [standard deviation], 4020 men). Coils, GS particles, and NBCA were used in 59%, 30%, and 11%, respectively. The overall early incidence of rebleeding and intestinal ischemia was 12% and 1.0%, respectively. With coils as the reference, the adjusted odds ratio for GS particles was 1.38 (95% CI: 1.15–1.66; p = 0.001) for early rebleeding and 2.64 (95% CI: 1.43–4.90; p = 0.002) for intestinal ischemia, and those for NBCA were 0.69 (95% CI: 0.50–0.95; p = 0.03) for early rebleeding and 3.53 (95% CI: 1.72–7.22; p = 0.001) for intestinal ischemia.

Conclusions

Compared with coils, GS particles were associated with an increase in both early rebleeding and intestinal ischemia, whereas NBCA was associated with decreased rebleeding and increased ischemia.

Key Points

Question Transcatheter arterial embolization (TAE) is one of the mainstay treatments for colonic diverticular bleeding, but outcome differences among embolic agents remain unclear.

Findings Gelatin sponge particles increased both early rebleeding and intestinal ischemic risks, while coils reduced intestinal ischemic risk and n‑butyl‑2‑cyanoacrylate reduced early rebleeding risk.

Clinical relevance Embolic material selection should be individualized for TAE in colonic diverticular bleeding. Coils may be safer in ischemia-prone patients, while n‑butyl‑2‑cyanoacrylate may be suitable for those at high risk of rebleeding.

Graphical Abstract