Revisiting the past: intra-arterial vasopressin for severe gastrointestinal bleeding in Crohn's disease

Technological advances in the last couple of decades have led to a tremendous improvement in the safety and efficacy of embolization making it the therapeutic intervention of choice in angiogram positive lower gastrointestinal bleeding. Vasopressin has thus been forgotten and it is hardly ever used by the current generation of interventionists. However, coil embolization is technically challenging and requires greater expertise. Difficulty in super-selective catheterization and lack of adequate collateralization can also prevent successful delivery of coils. In this article we present the successful use of intra-arterial vasopressin in a patient with Crohn's disease with severe lower gastrointestinal bleeding. Despite not being the first choice, vasopressin can be safely and effectively used in selected patients who are not candidates for embolotherapy. The purpose of this article is to discuss the relative merits and demerits of vasopressin vis-à-vis embolization and to identify the role of vasopressin in the current era of super-selective embolization. Successful control of massive lower gastrointestinal bleeding by intra-arterial vasopressin infusion has previously been reported only once before in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery in these patients.