Investigative modalities for massive lower gastrointestinal bleeding

Qahtani, Aayad R. Al; Satin, R; Stern, Jerry; Gordon, Philip H.

doi:10.1007/s00268-001-0279-x

Cited by 63 publications

(48 citation statements)

References 39 publications

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“…Accurate presurgical localization of the bleeding site decreases postoperative rates of morbidity and mortality [20]. With lower gastrointestinal bleeding, 10% to 15% of patients require surgery according to the literature [21]. In our series, 28% who had lower gastrointestinal bleeding (23 of 82) underwent surgery.…”

Section: Discussionmentioning

confidence: 85%

Treatment of gastrointestinal hemorrhage

et al. 2005

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Background: We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage. Methods: We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome. Results: Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization. Conclusion: Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instances.

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Section: Discussionmentioning

confidence: 85%

Treatment of gastrointestinal hemorrhage

et al. 2005

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“…[2] In the case of lower GIS bleedings, 80% will cease spontaneously without further intervention, about 25% of them will start to bleed again, and about 10-15% will require urgent operation. [3] It is essential to locate the site of bleeding before any intervention. The current methods for this purpose are endoscopy, angiography, and scintigraphic techniques.…”

Section: Resultsmentioning

confidence: 99%

“…[4] For this reason, some authors advocate the evaluation of patients with scintigraphic methods before undergoing endoscopy or angiography. [3,[5][6][7][8] The aim of this retrospective study is to report our clinical experience with red blood cell (RBC) scintigraphy and to discuss the role of this method in light of the contemporary literature.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies have recommended scintigraphic evaluation as the first method to be employed. [3,[5][6][7][8] In the present study, RBC scintigraphy was not the initial diagnostic method, since all patients had received at least one radiological examination prior to their referral to our clinic. However, no positive result was obtained in any of these examinations for the foci of the bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Şanlı

Özkan²,

Kuyumcu³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇGastrointestinal sistem (GİS) kanamalarında kanama odağı-nın saptanmasında, Tc-99m ile işaretli eritrosit (RBC) sintigrafisinin rolü klinik deneyimlerimiz ışığında değerlendirildi. GEREÇ VE YÖNTEM1995-2010 yılları arasında GİS kanaması odağının belirlenmesi amacıyla kliniğimize gönderilen 57 hasta (27 kadın, 30 erkek; ortalama yaş 43.9±24; dağılım 1-91 yıl) geriye dönük olarak çalışmaya alındı. Sintigrafi öncesi hastaların 51'ine gastroskopi, 45'ine kolonoskopi, 9'una anjiyografi yapılmıştı. BULGULARRBC sintigrafisi hastaların 31'inde pozitif ve 26'sında negatifti. Pozitif sintigrafik bulgular, 19 hastada ilk bir saatlik dinamik imajlarda, 7 hastada 1-4. saatler arası statik imajlarda, 5 hastada ise 4-24. saatler arasında alınan statik imajlarda kaydedildi. Toplam 14 hasta GİS kanaması nedeniyle ameliyat edildi. On üç hastada kanama yeri RBC sintigrafisi tanısıyla doğrulandı (doğruluk: %92,8). Ameliyat edilmeyen 43 hastanın 12'sinde nedeni bilinmeyen demir eksikliği anemisi vardı ki bu hastaların tümünde sintigrafi negatif olarak sonuçlandı. Yoğun kanama bulguları olan 4 hasta medikal takip sürecinde kaybedildi, geri kalan 27 hastanın kanamaları kendiliğinden ya da konservatif tedavilerle durdu. SONUÇÇalışmamız aktif GİS kanamalarında kanama odağının belirlenmesinde sintigrafinin primer yöntem olması gerekliliğini göstermektedir. Özellikle ilk 1 saatlik dinamik görün-tüleme esnasında saptanan pozitif imajlar, kanama odağı-nın doğru yerinin saptanmasında ve cerrahi gerekliliğin belirlenmesinde yol göstericidir.Anahtar Sözcükler: Gastrointestinal kanama; işaretli eritrosit sintigrafisi; endoskopik girişimler.

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“…Mesenteric angiography is one of the most often used procedures for diagnosis and treatment of an acute lower GI bleed, with a yield reported to be between 19%-92% [9][10][11] . In a review by Vernava et al [12] , mesenteric angiography localized the bleeding sites in 40% to 86% in 9 different studies.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli¹

2014

WJR

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AIM:To assess if certain triaging rules could be estab lished to optimize the yield of mesenteric angiography. METHODS:Medical records of 101 patients were ret rospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit (ICU) admission, and the number of packed red blood cells (PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results. RESULTS:We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older (73.2 years vs 65.9 years old) (P = 0.02).Angiogram was positive in 39.3 % (11/28) of patients admitted in ICU vs 23.2% (17/73) who were admitted elsewhere in the hospital (P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angio gram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9 (P = 0.02) and 2.1 ± 2.6 units (P = 0.04) received respectively in the same period. CONCLUSION:Older age, ICU admission, having re ceived at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Angiography; Diagnostic use; Colon; Blood supply; Radiograph; Gastrointestinal hemorrhage; Emer gencies; Mesenteric arteries Core tip: Mesenteric angiography is associated with a low yield of about 30%. We evaluated several factors in 101 patients undergoing mesenteric angiography in a tertiary care institution to see if any could be used for predicting a positive angiogram. We found that vital signs are poor discriminators but older age, intensive care unit admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study. We postulate that the reason is that patients are given enough blood units to compensate for blood loss and stabilize vital signs and therefore the number of blood units given indirectly correlate with severity of active bleeding.Rasuli P, Doumit J, Boulos M, Rizk C, Doumit G. Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed. World J Radiol 2014; 6(5): 218-222 Available from:

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Investigative modalities for massive lower gastrointestinal bleeding

Cited by 63 publications

References 39 publications

Treatment of gastrointestinal hemorrhage

Treatment of gastrointestinal hemorrhage

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

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