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Angiography in chronic/recurrent gastrointestinal bleeding: a nine year study
Insights
Panvisceral arteriography identified the source of chronic gastrointestinal bleeding in 43% of patients. This diagnostic imaging technique revealed arteriovenous malformations in the gastrointestinal tract, including rare cases in the gastric antrum and left colon.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Vascular Surgery
Background:
- Chronic/recurrent gastrointestinal bleeding presents significant physical, psychological, and socioeconomic challenges.
- Traditional diagnostic studies often fail to identify the bleeding source in these patients.
Purpose of the Study:
- To evaluate the diagnostic yield of aortography and panvisceral arteriography in patients with undiagnosed chronic/recurrent gastrointestinal bleeding.
- To identify specific lesions, particularly arteriovenous malformations, responsible for obscure gastrointestinal bleeding.
Main Methods:
- Sixty patients with undiagnosed chronic/recurrent gastrointestinal bleeding underwent aortography and panvisceral arteriography (celiac, superior mesenteric, and inferior mesenteric).
- Angiographic findings were analyzed to detect vascular lesions, with a focus on arteriovenous malformations.
Main Results:
- Angiography yielded positive results in 26 patients (43% diagnostic yield).
- Arteriovenous malformations were identified in 15 patients.
- Unique findings included arteriovenous malformations of the gastric antrum (3 patients) and left colon (4 patients), with état mammelonné observed in two gastric cases.
- Routine inferior mesenteric arteriography may explain the higher incidence of left colon arteriovenous malformations compared to other series.
Conclusions:
- Panvisceral arteriography is an effective diagnostic tool for identifying the source of chronic/recurrent gastrointestinal bleeding.
- The study highlights the significance of arteriovenous malformations, including rare locations, in obscure gastrointestinal bleeding.
- Continued use of panvisceral arteriography is warranted given its positive diagnostic yield in challenging cases.
Abstract:
Undiagnosed chronic/recurrent gastrointestinal bleeding, as defined, is a severe problem to those afflicted, both physically and psychologically as well as socioeconomically. During the past nine years, 60 such patients received aortography and panvisceral arteriography (that is, celiac, superior mesenteric, and inferior mesenteric arteriography) in a search for the lesions that may be responsible for the bleeding. Results of angiography were "positive" in 26 patients for a diagnostic yield of 43 per cent. Fifteen of the 26 patients with positive angiographic findings demonstrated arteriovenous malformations of the gastrointestinal tract. Two separate lesions were identified in three patients. This series is compared with other published series of angiography for chronic gastrointestinal bleeding. One difference from the other series is the demonstration of three patients with arteriovenous malformation of the gastric antrum. The diagnostic angiographic features of this condition are presented, along with the interestng finding of état mammelonné in two of the three patients. Another difference from the other series is the demonstration of four arteriovenous malformations involving the left side of the colon, whereas other series report none in this location. One possible explanation for this descrepancy is our routine use of inferior mesenteric arteriography in all cases of chronic gastrointestinal bleeding. Ten arteriovenous malformations of the colon are reported along with a review of the angiographic diagnostic features in this condition. The precise incidence of false-positive and false-negative diagnoses is unknown since surgery was not performed on all patients. However, each patient studied represented a total failure, by traditional diagnostic studies, to determine the cause of bleeding. The incidence of positive findings with angiography (43 per cent) in patients with undiagnosed chronic/recurrent gastrointestinal bleeding is sufficient to encourage the continued use of panvisceral arteriography in this condition.