Gastrointestinal Bleeding Successfully Treated Using Interventional Radiology

Abstract

Gastrointestinal (GI) bleeding is an emergency medical condition that leads to hemorrhagic shock or circulatory instability if left untreated. A mainstay for treating GI bleeding is endoscopic therapy; more than 90% of GI bleeding can be staunched by endoscopic hemostasis. However, patients with unstable hemodynamics or GI bleeding that cannot be controlled by endoscopy require transcatheter embolization or surgical intervention. The development of several devices and embolization agents that are used in interventional radiology (IVR) leads to safe and accessible treatment via IVR. If endoscopic treatment fails, IVR is the second strategy. Herein, we report cases of GI bleeding that were successfully treated by IVR and discuss the therapeutic strategy.

Gastrointestinal bleeding in patients admitted to the intensive care unit

“…It should be noted that in the group of patients who died, all had hemorrhagic shock at the time of admission, a fact that occurred only in 23% of the cases who survived. This highlights the prognostic value of the hemorrhagic shock and the importance of adequate early resuscitation in the management of these patients 21,22 .…”

Duodenal ulcer bleeding from a branch of the middle colic artery: A case report

“…[ 8 ] In addition to the GDA, arteries that feed the pancreaticoduodenal region, such as the IPDA and anterior superior pancreaticoduodenal artery, could also be culprit vessels for acute DUB. [ 2 , 3 ] In this case, the duodenal ulcer and its perforation could have damaged the main stem of the GDA and branching arteries of the IPDA and MCA, causing severe upper GI bleeding. To our knowledge, there have been no reports of DUB from a branch of the MCA, which might be due to congenital anomaly or the development of collateral blood vessels associated with past surgical history for internal organ rupture and duodenal ulcer.…”

“…Peptic ulcer disease is the most common cause of upper GI bleeding, and can be classified into gastric and duodenal ulcers. [ 1 ] Duodenal ulcer bleeding (DUB) is caused by the erosion of the duodenal arteries, such as the gastroduodenal artery (GDA), [ 2 , 3 ] and has been associated with higher mortality, surgical requirement, and readmission rates than gastric ulcer bleeding. [ 4 ] Therefore, it is crucial for clinicians to understand the treatment strategies and management options for acute DUB.…”

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

“…The typical candidates for endovascular hemostasis include the following: 1) those with acute GI bleeding that is refractory to endoscopic hemostasis; 2) those with massive bleeding that requires transfusion of more than four units of blood over 24 hours or those with unstable hemodynamic status, i.e., systolic blood pressure < 100 mmHg and heart rate > 100 beats per minute; and 3) those with recurrent bleeding. 5,10 Relative contraindications include renal insufficiency and uncorrectable coagulopathy. For patients with adverse reactions to iodine contrast medium, alternative contrast media, such as carbon dioxide, should be used.…”

“…4,9 There are many published reports regarding endovascular hemostasis in GI bleeding due to various causes. 5,10 In this article we will discuss the endovascular hemostasis of endoscopic procedure-related GI bleeding.…”