The Changing Paradigm for the Treatment of Colonic Hemorrhage

Abstract

Superselective embolization is effective in controlling colonic hemorrhage and is associated with a low rate of postembolization ischemia. Our experience with angiography reinforces the paradigm shift from its use as a diagnostic tool to the primary method for the control of colonic bleeding. Because patients have been followed up for as long as seven years, this approach remains effective for the long-term treatment of colonic bleeding.

The Management of Lower Gastrointestinal Hemorrhage

“…However, current literature is now suggesting that the paradigm has shifted and that TAE is now the primary method for the control of lower GI bleeding. 85,90 Kuo and colleagues 85 reported on 22 patients treated with superselective TAE for lower GI bleeding with initial control in all patients, rebleeding in three patients (14 percent), and no major complications. They reviewed another 122 patients in the literature and discovered a minor complication rate of 9 percent and major complication rate of 0 percent.…”

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

“…15,16 Management has also evolved with the advent of interventional endoscopy (bipolar coagulation, epinephrine injection, clip placement) 11,15,17,18 and angiographic treatment (intra-arterial infusion of vasopressin, transarterial embolization). [19][20][21][22] In the 10 patients treated on this last series and whose massive diverticular bleeding did not stop spontaneously, we could foresee haemostasis endoscopically in two and superselective embolization in four. Diverticular bleeding is caused by the rupture of small arteries, explaining the frequency of sudden haemorrhage associated with low blood pressure at admission, as observed in more than 25% of patients in this series.…”

The Efficacy and Durability of Super-Selective Embolization in the Treatment of Lower Gastrointestinal Bleeding

“…1 There are several published reports that establish the short-term safety and efficacy of superselective embolization for LGIB in small sample sizes (n= 9 to 39 embolizations) with limited or no follow-up. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Given this background, our objective was to review the short-term outcomes and long-term durability of superselective embolization in the treatment of lower gastrointestinal bleeding at Hartford Hospital.…”