Abstract
Gastrointestinal bleeding is commonly referred to interventional radiology for consultation. Endoscopy is the key first step for upper GI bleeding for both diagnosis and therapy, but colonoscopy is less frequently utilized for acute 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 most frequently targeted. 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%.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Park T, Wassef W. Nonvariceal upper gastrointestinal bleeding. Curr Opin Gastroenterol. 2014;30:603–8. https://doi.org/10.1097/MOG.0000000000000123.
Marion Y, Lebreton G, Le Pennec V, et al. The management of lower gastrointestinal bleeding. J Visc Surg. 2014;151:191–201. https://doi.org/10.1016/j.jviscsurg.2014.03.008.
Kim JJ, Sheibani S, Park S, et al. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48:113–8. https://doi.org/10.1097/MCG.0b013e318297fb40.
Hur S, Jae HJ, Lee M, et al. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol. 2014;25:10–9. https://doi.org/10.1016/j.jvir.2013.09.012.
Filippone A, Cianci R, Milano A, et al. Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis. Abdom Imaging. 2008;33:398–406. https://doi.org/10.1007/s00261-007-9271-8.
Duraiswamy S, Schmulewitz N, Rockey DC. The role of 99m Tc-RBC scintigraphy in lower gastrointestinal hemorrhage. J Investig Med. 2016;64:854–60. https://doi.org/10.1136/jim-2016-000077.
Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology. 2003;228:743–52. https://doi.org/10.1148/radiol.2283020756.
Feuerstein JD, Ketwaroo G, Tewani SK, et al. Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 2016;207:578–84. https://doi.org/10.2214/AJR.15.15714.
Choi C, Lim H, Kim MJ, et al. Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding. BMC Gastroenterol. 2020;20:426. https://doi.org/10.1186/s12876-020-01570-y.
Koh FH, Soong J, Lieske B, et al. Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference? Int J Color Dis. 2015;30:57–61. https://doi.org/10.1007/s00384-014-2055-z.
Mullady DK, Wang AY, Waschke KA. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology. 2020;159:1120–8. https://doi.org/10.1053/j.gastro.2020.05.095.
Greenspoon J, Barkun A, Bardou M, et al. Management of patients with nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2012;10:234–9. https://doi.org/10.1016/j.cgh.2011.07.025.
Repaka A, Atkinson MR, Faulx AL, et al. Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study. Gastrointest Endosc. 2012;76:367–73. https://doi.org/10.1016/j.gie.2012.03.1391.
Defreyne L, De Schrijver I, Decruyenaere J, et al. Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 2008;31:897–905. https://doi.org/10.1007/s00270-008-9320-x.
Eriksson LG, Ljungdahl M, Sundbom M, et al. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19:1413–8. https://doi.org/10.1016/j.jvir.2008.06.019.
Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol. 2003;14:535–43. https://doi.org/10.1097/01.rvi.0000064862.65229.8a.
Baum S, Athanasoulis CA, Waltman AC. Angiographic diagnosis and control of large-bowel bleeding. Dis Colon Rectum. 1974;17:447–53. https://doi.org/10.1007/BF02587018.
Loffroy R, Rao P, Ota S, et al. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010;33:1088–100. https://doi.org/10.1007/s00270-010-9829-7.
Padia SA, Geisinger MA, Newman JS, et al. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol. 2009;20:461–6. https://doi.org/10.1016/j.jvir.2009.01.006.
Yu Q, Funaki B, Navuluri R, et al. Empiric transcatheter embolization for acute arterial upper gastrointestinal bleeding: a meta-analysis. AJR Am J Roentgenol. 2021;216:880–93. https://doi.org/10.2214/AJR.20.23151.
d’Othee BJ, Surapaneni P, Rabkin D, et al. Microcoil embolization for acute lower gastrointestinal bleeding. Cardiovasc Intervent Radiol. 2006;29:49–58. https://doi.org/10.1007/s00270-004-0301-4.
Funaki B, Kostelic JK, Lorenz J, et al. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol. 2001;177:829–36. https://doi.org/10.2214/ajr.177.4.1770829.
Kuo WT, Lee DE, Saad WE, et al. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2003;14:1503–9. https://doi.org/10.1097/01.rvi.0000099780.23569.e6.
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;10:391–7. https://doi.org/10.3348/kjr.2009.10.4.391.
Lipof T, Sardella WV, Bartus CM, et al. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum. 2008;51:301–5. https://doi.org/10.1007/s10350-007-9149-4.
Neuman HB, Zarzaur BL, Meyer AA, et al. Superselective catheterization and embolization as first-line therapy for lower gastrointestinal bleeding. Am Surg. 2005;71:539–44; discussion 544-535
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;9:343–52. https://doi.org/10.1016/j.gassur.2004.09.039.
Peck DJ, McLoughlin RF, Hughson MN, et al. Percutaneous embolotherapy of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 1998;9:747–51. https://doi.org/10.1016/s1051-0443(98)70386-0.
Tan KK, Wong D, Sim R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg. 2008;32:2707–15. https://doi.org/10.1007/s00268-008-9759-6.
Kodani M, Yata S, Ohuchi Y, et al. 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;27:824–30. https://doi.org/10.1016/j.jvir.2016.01.140.
Koo HJ, Shin JH, Kim HJ, 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;204:662–8. https://doi.org/10.2214/AJR.14.12683.
Yata S, Kaminou T, Ogawa T, et al. Reply to “transcatheter arterial embolization of acute arterial bleeding in the upper and lower gastrointestinal tract with N-butyl-2-cyanoacrylate”. J Vasc Interv Radiol. 2013;24:919–20. https://doi.org/10.1016/j.jvir.2013.03.004.
Kim PH, Tsauo J, Shin JH, et al. Transcatheter arterial embolization of gastrointestinal bleeding with n-butyl cyanoacrylate: a systematic review and meta-analysis of safety and efficacy. J Vasc Interv Radiol. 2017;28:522–531 e525. https://doi.org/10.1016/j.jvir.2016.12.1220.
Jae HJ, Chung JW, Kim HC, 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;19:755–63. https://doi.org/10.1016/j.jvir.2008.01.024.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ushinsky, A., Darcy, M. (2024). GI Bleeding. In: Keefe, N.A., Haskal, Z.J., Park, A.W., Angle, J.F. (eds) IR Playbook. Springer, Cham. https://doi.org/10.1007/978-3-031-52546-9_30
Download citation
DOI: https://doi.org/10.1007/978-3-031-52546-9_30
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-52545-2
Online ISBN: 978-3-031-52546-9
eBook Packages: MedicineMedicine (R0)