Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature

Abstract

Lower gastrointestinal bleeding is common and occurs often in elderly patients. In rare cases it is associated with hemorrhagic shock. A large number of such bleedings, which are often caused by colon diverticula, subside spontaneously. Alternatively they can be treated by endoscopic procedures successfully. Given the aging population of our society, the rising incidence of lower gastrointestinal tract bleeding and new anticoagulant therapies, some of the bleedings tend to be severe. Colonoscopy is the established standard procedure for the diagnosis and treatment of lower gastrointestinal bleeding. However, a small number of patients experience re-bleeding or shock; their bleeding does not resolve spontaneously and cannot be treated successfully by endoscopic procedures. In such patients, interventional radiology is very useful for the detection of bleeding and the achievement of hemostasis. Against this background we performed a literature search using PubMed to identify all relevant studies focused on the endoscopic and radiological management of lower gastrointestinal bleeding and present recent conclusions on the subject.

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

“…[17] In contrast, CTAs have been shown to provide increased information before colonoscopy in only 15% of cases. [18] In our series, the location of bleeds seen on TAI corresponded to the areas seen on prior investigative modalities, most of the time, 93% for SC, 92% for NM, and 80% for CTA. ese findings support the utility of diagnostic studies before TAI.…”

Endoscopic hemostasis makes the difference: Angiographic treatment in patients with lower gastrointestinal bleeding

“…An analysis of 2528 patients revealed that a quarter of the patients received transfusions and 10% needed more than four red cell concentrates[ 1 ]. Endoscopy discloses the bleeding in no more than 40% of cases[ 2 ]. Diverticular bleeding is the most frequent cause of LGIB, accounting for 30%-65% of all cases.…”

“…As many as 80% of these subside spontaneously[ 3 ]. Further frequent causes of bleeding are angiodysplasia and hemorrhoids, as well as cancer[ 2 , 4 ]. Once the bleeding is identified on endoscopy, more than 90% of these can be treated successfully.…”

“…Especially in cases of severe bleeding not amenable to endoscopic treatment, surgery serves an additional invasive therapy option[ 2 , 4 ]. Besides, interventional radiology has emerged as an important alternative in the last few years.…”

“…Currently, radiological diagnostic investigation and treatment are largely oriented to local facilities. These include, in particular, the availability of therapeutic endoscopy and interventional radiology[ 2 ]. Interdisciplinary cooperation between gastroenterologists and radiologists is obviously a crucial factor.…”