Clin Endosc.  2013 Sep;46(5):486-491.

Refractory Gastrointestinal Bleeding: Role of Angiographic Intervention

• Shin JH

Abstract

Although endoscopic hemostasis remains initial treatment modality for nonvariceal gastrointestinal (GI) bleeding, severe bleeding despite endoscopic management occurs in 5% to 10% of the patients, requiring surgery or transcatheter arterial embolization (TAE). TAE is now considered the first-line therapy for massive GI bleeding refractory to endoscopic management. GI endoscopists need to be familiar with indications, principles, outcomes, and complications of TAE, as well as embolic materials available.

Keyword

Gastrointestinal tract; Hemorrhage; Embolization

MeSH Terms

Gastrointestinal Tract
Hemorrhage
Hemostasis, Endoscopic
Humans

Figure

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  Fig. 1 A 56-year-old man with pancreatic cancer with duodenal invasion. He had undergone biliary and duodenal stents and presented with hematemesis which was uncontrollable by endoscopy. (A, B) Superior mesenteric artery (SMA, arrows) angiograms show active massive bleeding (arrowheads) into the duodenum. (C) N-butyl-cyanoacrylate (NBCA) embolization (NBCA:lipiodol=1:2) was performed to control the bleeding. NBCA cast (arrows) is seen in the SMA. (D) Celiac angiogram shows no further bleeding through collaterals. There was collateral supply to the distal branches of the SMA on inferior mesenteric angiogram (not shown).

• 

  Fig. 2 A 56-year-old woman with ileal angiodysplasia. (A) Superior mesenteric artery (SMA) angiogram shows increased vascularity (arrows) of the ileum. There was early venous drainage on delayed image (not shown). (B) SMA angiogram after embolization with polyvinyl alcohol shows embolization at the proximal arc level (arrow). The ileal branches distal to the embolization level are not seen. (C) Computed tomography (CT) scan 2 days later shows bowel ischemic change (arrows) and complicated fluid collection (asterisk) with air, suggesting bowel perforation. (D) Exploration was done the next day after CT scans with resection of the ileal segment with transmural necrosis.

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