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Treatment of gastrointestinal hemorrhage
P Charbonnet1, J Toman, L Bühler
1Clinique et Policlinique de Chirurgie digestive, Hôpital Universitaire de Genève, Switzerland. pierre.charbonnet@hcuge.ch
Insights
Selective arteriography can identify gastrointestinal bleeding sources in about one-third of patients. Transcatheter embolization effectively achieves hemostasis in most cases, offering a valuable diagnostic and management tool.
Area of Science:
- Radiology
- Gastroenterology
- Interventional Radiology
Background:
- Acute gastrointestinal hemorrhage presents diagnostic and management challenges.
- Selective arteriography is a key imaging modality for evaluating bleeding sources.
- Understanding its diagnostic yield and therapeutic potential is crucial.
Purpose of the Study:
- To evaluate the diagnostic accuracy of selective arteriography in identifying acute gastrointestinal bleeding.
- To assess the efficacy of selective embolization in achieving hemostasis for gastrointestinal hemorrhage.
- To determine the overall value of arteriography in managing patients with gastrointestinal bleeding.
Main Methods:
- Retrospective review of 107 patients with gastrointestinal hemorrhage undergoing selective arteriography (1992-2003).
- Analysis of angiographic findings, including extravasation and indirect signs of bleeding.
- Assessment of transcatheter embolization success rates and need for subsequent surgery.
Main Results:
- Selective arteriography correctly identified the bleeding site in 36 of 129 studies (28%).
- Extravasation was visualized in 24 cases, with the colon being the most common site (n=16).
- Transcatheter embolization achieved definitive hemostasis in 11 of 15 attempted cases (73%), with successful treatment in the stomach, small bowel, colon, and liver.
Conclusions:
- Abdominal arteriography can localize gastrointestinal bleeding sources in approximately one-third of patients.
- Selective embolization is an effective method for achieving definitive hemostasis in most patients.
- Arteriography plays a significant role in both diagnosis and management of acute gastrointestinal hemorrhage.
Background:
We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage.
Methods:
We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome.
Results:
Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization.
Conclusion:
Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instances.
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