Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin

Acute gastrointestinal bleeding (GIB) is an emergency with high mortality rates, which requires a quick localization and treatment of the bleeding site. In this article, we give a summary of the diagnostic and interventional treatment of acute GIB with an emphasis on radiological methods.

The MEDLINE database identified relevant studies up until January 2011. Furthermore, experiences drawn from a highly experienced department of diagnostic radiology (~60 transarterial embolizations [TAEs]/year) were taken into account.

Clinical risk scores are useful tools to triage patients for appropriate treatment. High-risk patients should undergo emergency endoscopy within 24 h. If endoscopical control of the bleeding cannot be achieved, a computed tomography angiography (CTA) should be done. If active bleeding (or if an active bleeding site) is found, in most cases, TAE should be performed prior to surgery because of the equal mortality rates with lower complication rates. If the site of bleeding is not identified and the patient is stable, a "watch-and-wait" strategy can be pursued. Especially for intermittent bleeding, scintigraphy with tagged red blood cells can be useful.

Managing obscure acute GIB remains a challenge. The best patient care is achieved with a multidisciplinary team of endoscopists, experienced surgeons, and interventional radiologists. If emergency endoscopy fails, a CTA has to be done, which is more sensitive than conventional angiography. Based on CTA findings, a decision must be made between TAE and surgical intervention.