Superselective Transcatheter Embolization to Halt an Arterial Esophageal Hemorrhage: Is the Use of N-Butyl Cyanoacrylate the Best Choice?

whom reported on the effectiveness of selective emboliza-tion using N-butyl cyanoacrylate (NBCA) in patients withacute arterial esophageal bleeding. We have severalcomments: over the last decade, transcatheter arterialembolization (TAE) has gained widespread acceptance as afirst-line treatment for endoscopic therapy-resistant, acutenonvariceal upper gastrointestinal bleeding (1, 2). The rateof efficacy for this approach in the initial hemostasis ofsuch a condition has been reported to range from 52% to97% (1-3). Coils have emerged as the currently preferredembolic agent for treating upper gastrointestinalhemorrhage. However, higher rates of recurrent bleedinghave been reported with coil embolization, especially inpatients with coagulopathy (3). We recently reported ourresults of nearly 10 years of arterial embolizationtreatment for cases of refractory massive bleeding from theupper gastrointestinal tract (3). Our report includes 60patients, which makes it one of the largest case-seriesstudies of this sort in the existing literature. Using coilsalone to occlude the feeding artery, as well as the presenceof a coagulation disorder defined as having an interna-tional normalized ratio greater than 1.5, partial thrombo-plastin time longer than 45 seconds, or a platelet count lessthan 80,000/mm