Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

Song, Jin Su; Kwak, Hyo-Sung; Chung, Gyung Ho

doi:10.3348/kjr.2011.12.4.482

Cited by 3 publications

(3 citation statements)

References 27 publications

(22 reference statements)

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“…Entre los múltiples agentes utilizados para ocluir los vasos sanguíneos, están las micropartículas, los espirales, los líquidos y el Gelfoam™ 15,16 .…”

Section: Agentes Para Generar Emboliaunclassified

Manejo endovascular de la hemorragia digestiva, experiencia del Hospital Universitario Clínica San Rafael

Jiménez¹,

Randial

Quiroga³

2019

Rev Colomb Cir

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Introducción. La hemorragia digestiva ocasiona el 2 % de las hospitalizaciones; se clasifica en alta o baja, la primera se presenta en el 80 % de casos. Después de la estabilización hemodinámica, se determinan la causa y el tratamiento mediante la endoscopia; no obstante, esta falla en 10 a 20 % de los casos, y del 15 al 20 % requieren cirugía mayor, con una mortalidad de más del 40 %. El tratamiento para la hemorragia digestiva mediante la formación de émbolos de los vasos mesentéricos, es una conducta bien establecida, produce buenos resultados, evita la cirugía y disminuye la morbimortalidad. Objetivos. Determinar la indicación y el éxito del tratamiento endovascular para la hemorragia digestiva en nuestra institución. Materiales y métodos. estudio retrospectivo y descriptivo, se incluyeron 10 pacientes que requirieron la urgente formación de émbolos por falla o imposibilidad del manejo endoscópico, y que presentaban gran riesgo quirúrgico y anestésico con la técnica abierta. Se evaluaron la causa de la hemorragia, la arteria comprometida, los hallazgos angiográficos, la hemoglobina antes y después de la formación de los émbolos, la reincidencia de la hemorragia, las complicaciones, la necesidad de intervención quirúrgica, la eficacia del procedimiento y la mortalidad a 30 días. Resultados. Todos los pacientes se intervinieron por vía endovascular, para la oclusión selectiva de las arterias comprometidas. La hemorragia se controló en todos ellos. Se presentaron dos muertes tempranas (<30 días) no asociadas con el procedimiento. No hubo complicaciones secundarias a la formación de los émbolos o al acceso percutáneo y, tampoco, necesidad de cirugías mayores posteriores para controlar la hemorragia. Conclusión. Los métodos endovasculares para controlar la hemorragia digestiva son eficaces, no se acompañan de complicaciones, y disminuyen la morbimortalidad y la necesidad de cirugías mayores. Se requieren estudios con mayor número de pacientes para lograr un mayor grado de certeza.

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“…Entre los múltiples agentes utilizados para ocluir los vasos sanguíneos, están las micropartículas, los espirales, los líquidos y el Gelfoam™ 15,16 .…”

Section: Agentes Para Generar Emboliaunclassified

Manejo endovascular de la hemorragia digestiva, experiencia del Hospital Universitario Clínica San Rafael

Jiménez¹,

Randial

Quiroga³

2019

Rev Colomb Cir

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“…19 If no extravasation is seen, despite the injection of contrast medium, the branches terminating at the clip are then superselected using microcatheter techniques and are embolized. 20,21 Oblique views can provide a clearer view of colic vessels in flexures. In addition, right and left anterior oblique views open up hepatic and splenic flexures.…”

Section: Techniques Of Endovascular Hemostasismentioning

confidence: 99%

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

Park

Kim

Shin

2019

Int J Gastrointest Interv

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Gastrointestinal (GI) bleeding is a common complication of various endoscopic procedures. In most cases, GI bleeding responds to conservative management. And if indicated, endoscopic hemostasis is performed. However, if endoscopic hemostasis fails due to massive bleeding or hemodynamically unstable patients, alternative treatment options, such as endovascular hemostasis or surgery, should be considered. As endoscopic procedures have become more diverse, there have been reports of interventional treatment of endoscopic, procedure-related GI bleeding. In this article we will discuss the endovascular diagnosis and treatment of endoscopic, procedure-related GI bleeding.

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“…Only arterial or capillary bleeding can be detected by selective visceral arteriography; venous bleeding is rarely detected on the venous phase of an arteriogram. Marking the site of bleeding during endoscopy aids in accurate localization of the bleeding source [32].…”

Section: Variant and Procedures Informationmentioning

confidence: 99%

ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding

Singh-Bhinder

Kim

Holly

et al. 2017

Journal of the American College of Radiology

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Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

Cited by 3 publications

References 27 publications

Manejo endovascular de la hemorragia digestiva, experiencia del Hospital Universitario Clínica San Rafael

Manejo endovascular de la hemorragia digestiva, experiencia del Hospital Universitario Clínica San Rafael

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding

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