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Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin
E S Rollins1, D Picus, M E Hicks
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Visceral angiography is valuable for diagnosing chronic gastrointestinal bleeding when other methods fail. This study found it identified the cause in 44% of patients with obscure bleeding, proving its diagnostic utility.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
Background:
- Chronic gastrointestinal bleeding presents a diagnostic challenge.
- Newer noninvasive procedures like endoscopy and barium studies have improved diagnosis.
- However, some patients still present with bleeding of unknown origin.
Purpose of the Study:
- To evaluate the diagnostic role of visceral angiography.
- To assess its utility in patients with obscure gastrointestinal bleeding after noninvasive workup.
Main Methods:
- Visceral angiograms were obtained in 36 patients with chronic gastrointestinal bleeding.
- Patients had previously undergone extensive noninvasive diagnostic evaluations.
- The study period was between 1983 and 1990.
Main Results:
- Angiography established the cause of bleeding in 16 patients (44%).
- Structural abnormalities without active bleeding were found in 11 cases.
- No false-positive angiograms were recorded, with a 8% false-negative rate (3 cases).
- No complications occurred during the procedures.
Conclusions:
- Visceral angiography is an important tool for diagnosing obscure gastrointestinal bleeding.
- It provides a positive diagnosis in a significant number of patients.
- Angiography remains valuable despite advancements in noninvasive techniques.
Abstract:
The treatment of patients with chronic gastrointestinal bleeding can be a frustrating diagnostic challenge. In the past 10-15 years, a variety of new diagnostic procedures (e.g., fiber-optic endoscopy, scintigraphy, and double-contrast barium studies) have become available to examine these patients. Despite these new procedures, a small number of patients continue to bleed without a defined cause. We sought to evaluate the role of visceral angiography in patients with chronic gastrointestinal bleeding in whom findings on an extensive noninvasive workup have been normal. Between 1983 and 1990, we obtained angiograms on 36 such patients. The cause of bleeding was established by angiography in 16 patients (44%). In 11 of these 16, angiography revealed only a structural abnormality without active bleeding. Twenty patients had normal angiographic findings. No angiograms were false-positive, but three were false-negative (8%). No complication occurred as a result of the angiographic procedures. Our experience shows that visceral angiography can provide a positive diagnosis in a significant number of patients with chronic gastrointestinal bleeding of obscure origin in whom all other diagnostic measures have been unrevealing. Despite improvements in noninvasive diagnostic techniques, angiography still remains an important tool for examining this group of patients.