Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli, Pasteur

doi:10.4329/wjr.v6.i5.218

Cited by 16 publications

(9 citation statements)

References 20 publications

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“…Angiography requires blood loss rates > 0.5 mL/min to localize a bleeding site[62]. Transfusion of > 5 units of red blood cells or 4 units of fresh frozen plasma within 24 h, hemodynamic instability at the time of angiography, and older age are predictors of a positive angiography[63,64]. In addition, CT angiography may be useful as a noninvasive diagnostic tool before angiography, because it is more sensitive than transcatheter angiography and identifies bleeding at rates of 0.3 mL/min[65].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Initial management for acute lower gastrointestinal bleeding

Aoki

Hirata

Yamada

et al. 2019

WJG

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Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospital admission. Patients with LGIB often experience persistent or recurrent bleeding and require blood transfusions and interventions, such as colonoscopic, radiological, and surgical treatments. Appropriate decision-making is needed to initially manage acute LGIB, including emergency hospitalization, timing of colonoscopy, and medication use. In this literature review, we summarize the evidence for initial management of acute LGIB. Assessing various clinical factors, including comorbidities, medication use, presenting symptoms, vital signs, and laboratory data is useful for risk stratification of severe LGIB, and for discriminating upper gastrointestinal bleeding. Early timing of colonoscopy had the possibility of improving identification of the bleeding source, and the rate of endoscopic intervention, compared with elective colonoscopy. Contrast-enhanced computed tomography before colonoscopy may help identify stigmata of recent hemorrhage on colonoscopy, particularly in patients who can be examined immediately after the last hematochezia. How to deal with nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents after hemostasis should be carefully considered because of the risk of rebleeding and thromboembolic events. In general, aspirin as primary prophylaxis for cardiovascular events and NSAIDs were suggested to be discontinued after LGIB. Managing acute LGIB based on this information would improve clinical outcomes. Further investigations are needed to distinguish patients with LGIB who require early colonoscopy and hemostatic intervention.

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Section: Diagnosis and Treatmentmentioning

confidence: 99%

Initial management for acute lower gastrointestinal bleeding

Aoki

Hirata

Yamada

et al. 2019

WJG

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“… 4 Recently, the development of new technologies such as interventional endoscopy, angiography, and laparoscopic surgery has led to a change in the management of patients with colonic diverticular bleeding. 5 – 7 Colectomy is still necessary in extreme settings and when less invasive procedures are unsuccessful or unavailable. Although this topic has been the subject of several studies in the recent past, the question of what is the best treatment for acute diverticular bleeding still remains unanswered.…”

Section: Introductionmentioning

confidence: 99%

New Trends in Acute Management of Colonic Diverticular Bleeding

et al. 2015

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Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding.The aim of this systematic review is to define the best treatment for colonic diverticular bleeding.A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology.The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding.Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments.Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former.

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“…The wide range of reported clinical sensitivities with conventional angiography has hindered the procedure’s potential clinical utility. Multiple studies have demonstrated an association with hemodynamic instability and number of units of pRBC transfused, whereas others have shown no such associations [ 13 , 22 , 23 , 24 ]. In this study, ΔHct over the previous 24 h was the only significant independent predictor of a positive angiographic study in all indications, a relationship that also held true in the specific context of GIB.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Active Extravasation and Complications after Conventional Angiography for Acute Intraabdominal Bleeding

Haber

Charles

Erinjeri

et al. 2017

JCM

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Conventional angiography is used to evaluate and treat possible sources of intraabdominal bleeding, though it may cause complications such as contrast-induced nephropathy (CIN). The study’s purpose was to identify factors predicting active extravasation and complications during angiography for acute intraabdominal bleeding. All conventional angiograms for acute bleeding (January 2013–June 2015) were reviewed retrospectively, including 75 angiograms for intraabdominal bleeding in 70 patients. Demographics, comorbidities, vital signs, complications within one month, and change in hematocrit (ΔHct) and fluids and blood products administered over the 24 h prior to angiography were recorded. Of 75 exams, 20 (27%) demonstrated extravasation. ΔHct was the only independent predictor of extravasation (p = 0.017), with larger ΔHct (−17%) in patients with versus those without extravasation (–1%) (p = 0.01). CIN was the most common complication, occurring in 10 of 66 angiograms (15%). Glomerular filtration rate (GFR) was the only independent predictor (p = 0.03); 67% of patients with GFR < 30, 29% of patients with GFR 30–60, and 8% of patients with GFR > 60 developed CIN. For patients with intraabdominal bleeding, greater ΔHct decrease over 24 h before angiography predicts active extravasation. Pre-existing renal impairment predicts CIN. Patients with large hematocrit declines should be triaged for rapid angiography, though benefits can be weighed with the risk of renal impairment.

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Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Cited by 16 publications

References 20 publications

Initial management for acute lower gastrointestinal bleeding

Initial management for acute lower gastrointestinal bleeding

New Trends in Acute Management of Colonic Diverticular Bleeding

Predictors of Active Extravasation and Complications after Conventional Angiography for Acute Intraabdominal Bleeding

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