Advertisement

IR Playbook pp 305-312 | Cite as

GI Bleeding

  • Michael Darcy
Chapter

Abstract

Gastrointestinal bleeding is a very common clinical problem that frequently gets referred to interventional radiology for therapy. Endoscopy is the key first step for upper GI bleeding for both diagnosis and therapy but is less frequently utilized for lower GI bleeding. For lower GI bleeding, CT angiography is the preferred screening test to determine if bleeding is sufficient to warrant arteriography and embolization. Upper GI embolization can be done safely and effectively in the majority of cases with the main gastroduodenal or left gastric arteries being the target in most cases. Lower GI embolization involves super-selective embolization at the level of the vasa recta in order to avoid ischemia. When performed at that level, the rate of significant ischemia is less than 5%.

Keywords

Gastrointestinal bleeding Upper GI bleeding Lower GI bleeding Mesenteric arteriography Celiac arteriography Superior mesenteric arteriography Inferior mesenteric arteriography Embolization 

References

  1. 1.
    Park T, Wassef W. Nonvariceal upper gastrointestinal bleeding. Curr Opin Gastroenterol. 2014;30(6):603–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Marion Y, Lebreton G, Le Pennec V, Hourna E, Viennot S, Alves A. The management of lower gastrointestinal bleeding. J Visc Surg. 2014;151(3):191–201.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(2):113–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Hur S, Jae HJ, Lee M, Kim HC, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol. 2014;25(1):10–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Filippone A, Cianci R, Milano A, Valeriano S, Di Mizio V, Storto ML. Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis. Abdom Imaging. 2008;33(4):398–406.CrossRefPubMedGoogle Scholar
  6. 6.
    Duraiswamy S, Schmulewitz N, Rockey DC. The role of 99m Tc-RBC scintigraphy in lower gastrointestinal hemorrhage. J Investig Med. 2016;64(4):854–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology. 2003;228(3):743–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Feuerstein JD, Ketwaroo G, Tewani SK, Cheesman A, Trivella J, Raptopoulos V, et al. Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 2016;207(3):578–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Koh FH, Soong J, Lieske B, Cheong WK, Tan KK. Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference? Int J Color Dis. 2015;30(1):57–61.CrossRefGoogle Scholar
  10. 10.
    Greenspoon J, Barkun A, Bardou M, Chiba N, Leontiadis GI, Marshall JK, et al. Management of patients with nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2012;10(3):234–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Defreyne L, De Schrijver I, Decruyenaere J, Van Maele G, Ceelen W, De Looze D, et al. Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 2008;31(5):897–905.CrossRefPubMedGoogle Scholar
  12. 12.
    Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19(10):1413–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol. 2003;14(5):535–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Baum S, Athanasoulis CA, Waltman AC. Angiographic diagnosis and control of large-bowel bleeding. Dis Colon Rectum. 1974;17(4):447–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Repaka A, Atkinson MR, Faulx AL, Isenberg GA, Cooper GS, Chak A, et al. Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study. Gastrointest Endosc. 2012;76(2):367–73.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010;33(6):1088–100.CrossRefPubMedGoogle Scholar
  17. 17.
    Padia SA, Geisinger MA, Newman JS, Pierce G, Obuchowski NA, Sands MJ. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol. 2009;20(4):461–6.CrossRefPubMedGoogle Scholar
  18. 18.
    d'Othee BJ, Surapaneni P, Rabkin D, Nasser I, Clouse M. Microcoil embolization for acute lower gastrointestinal bleeding. Cardiovasc Intervent Radiol. 2006;29(1):49–58.CrossRefPubMedGoogle Scholar
  19. 19.
    Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, et al. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol. 2001;177(4):829–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2003;14(12):1503–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Kwak HS, Han YM, Lee ST. The clinical outcomes of transcatheter microcoil embolization in patients with active lower gastrointestinal bleeding in the small bowel. Korean J Radiol. 2009;10(4):391–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum. 2008;51(3):301–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Neuman HB, Zarzaur BL, Meyer AA, Cairns BA, Rich PB. Superselective catheterization and embolization as first-line therapy for lower gastrointestinal bleeding. Am Surg. 2005;71(7):539–44; discussion 44–5.PubMedGoogle Scholar
  24. 24.
    Khanna A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2005;9(3):343–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Peck DJ, McLoughlin RF, Hughson MN, Rankin RN. Percutaneous embolotherapy of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 1998;9(5):747–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Tan KK, Wong D, Sim R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg. 2008;32(12):2707–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Kodani M, Yata S, Ohuchi Y, Ihaya T, Kaminou T, Ogawa T. Safety and risk of superselective transcatheter arterial embolization for acute lower gastrointestinal hemorrhage with N-butyl cyanoacrylate: angiographic and colonoscopic evaluation. J Vasc Interv Radiol. 2016;27(6):824–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Koo HJ, Shin JH, Kim HJ, Kim J, Yoon HK, Ko GY, et al. Clinical outcome of transcatheter arterial embolization with N-butyl-2-cyanoacrylate for control of acute gastrointestinal tract bleeding. AJR Am J Roentgenol. 2015;204(3):662–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Yata S, Ihaya T, Kaminou T, Hashimoto M, Ohuchi Y, Umekita Y, et al. Transcatheter arterial embolization of acute arterial bleeding in the upper and lower gastrointestinal tract with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol. 2013;24(3):422–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Jae HJ, Chung JW, Kim HC, So YH, Lim HG, Lee W, et al. Experimental study on acute ischemic small bowel changes induced by superselective embolization of superior mesenteric artery branches with N-butyl cyanoacrylate. J Vasc Interv Radiol. 2008;19(5):755–63.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Chief of Interventional Radiolgy, Mallinckrodt Institute of RadiologyWashington University in St LouisSt. LouisUSA

Personalised recommendations