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Diagnosis and percutaneous treatment of gastrointestinal hemorrhage. Long-term experience
J M Carreira1, R Reyes, J M Pulido-Duque
1Laboratorio de Radiología, Facultad de Medicina, Santiago de Compostela, La Coruña, 15704, España.
Insights
Diagnostic angiography and therapeutic embolization are effective treatments for gastrointestinal hemorrhage. These less aggressive methods successfully resolved bleeding in most patients, with few complications, becoming essential tools for managing severe cases.
Area of Science:
- Gastroenterology
- Interventional Radiology
Background:
- Gastrointestinal hemorrhage (GIH) is a significant clinical challenge.
- Effective diagnostic and therapeutic strategies are crucial for managing GIH.
Purpose of the Study:
- To evaluate the efficacy and safety of diagnostic angiography and percutaneous therapeutic embolization for gastrointestinal hemorrhage.
- To assess the role of these interventional techniques in patients unresponsive to conservative management.
Main Methods:
- A retrospective study of 196 patients with GIH (upper and lower) from April 1987 to April 1997.
- Patients underwent diagnostic angiography, and therapeutic embolization was employed when indicated.
- Exclusion criteria included bleeding from esophageal varices.
Main Results:
- Angiography identified a bleeding source in 33% of patients.
- Therapeutic embolization was performed in 67% of patients, achieving technical success in 89% and clinical resolution in 80%.
- Complications were relatively low, including arterial spasm and pain; serious complications like celiac trunk dissection occurred in 2 patients.
Conclusions:
- Diagnostic angiography and percutaneous therapeutic embolization are effective and less invasive options for managing GIH.
- These interventional radiology techniques are indispensable for patients with refractory GIH.
- Embolization can be successful even in selected patients without evident angiographic bleeding.
Objective:
to report our experience in the diagnosis and treatment of gastrointestinal hemorrhage.
Method:
from April 1987 to April 1997, 196 patients with gastrointestinal hemorrhage (134 men and 62 women) were studied. 165 (84%) were diagnosed as presenting upper gastrointestinal hemorrhage, and 31 (16%) presented lower gastrointestinal hemorrhage. The patients were studied with endoscopy and arteriography, and embolization was prescribed in 131 (67%). Patients with bleeding from esophageal varices were excluded from this study.
Results:
a bleeding point was identified angiographically in 33% (n = 65) patients. 131 (67%) patients were treated with therapeutic embolization, which was successful in 89% (n = 116) patients. The bleeding was resolved in 80% (n = 93) of the patients. Complications included arterial spasm (n = 12), pain (n = 24), coil migration (n = 8), allergic reaction (n = 2) and celiac trunk dissection (n = 2). During follow-up 16 patients presented rebleeding that stopped after reembolization in 9 cases, whereas in 7 cases surgery was needed.
Conclusions:
in our experience, diagnostic angiography and percutaneous therapeutic embolization are effective, less aggressive methods that lead to few complications. Both methods have become indispensable tools in managing patients with gastrointestinal hemorrhage that does not respond to conservative therapy. Even in patients with no evidence of angiographic bleeding, embolization in selected patients is successful.