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Meram E, Russell E, Ozkan O, Kleedehn M. Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology. Gastrointest Endosc Clin N Am 2024; 34:275-299. [PMID: 38395484 DOI: 10.1016/j.giec.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
For over 60 years, diagnostic and interventional radiology have been heavily involved in the evaluation and treatment of patients presenting with gastrointestinal bleeding. For patients who present with upper GI bleeding and have a contraindication to endoscopy or have an unsuccessful attempt at endoscopy for identifying or controlling the bleeding, interventional radiology is often consulted for evaluation and consideration of catheter-based intervention.
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Affiliation(s)
- Ece Meram
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elliott Russell
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Orhan Ozkan
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Mark Kleedehn
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA.
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Garg T, Khorshidi F, Habibollahi P, Shrigiriwar A, Fang A, Sakiani S, Harfouche M, Diaz JJ, Nezami N. How I Do It: Endovascular Management of Acute Nonvariceal Gastrointestinal Bleeding. Semin Intervent Radiol 2023; 40:475-490. [PMID: 37927517 PMCID: PMC10622246 DOI: 10.1055/s-0043-1775850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sasan Sakiani
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Melike Harfouche
- Division Acute Care Surgery, University of South Florida/Tampa General Hospital, Tampa, Florida
| | - Jose J. Diaz
- Division Acute Care Surgery, University of South Florida/Tampa General Hospital, Tampa, Florida
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, Colleague Park, Maryland
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3
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Chou KY, Chen WY, Cheng HC, Cheng CL. Low dose intra-arterial vasopressin infusion as rescue treatment for small bowel bleeding with severe thrombocytopenia. Br J Hosp Med (Lond) 2022; 83:1-3. [PMID: 36594764 DOI: 10.12968/hmed.2022.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kuan-Yu Chou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Ying Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsiu-Chi Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Lan Cheng
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lee S, Kim T, Han SC, Pak H, Jeon HH. Transcatheter arterial embolization for gastrointestinal bleeding: Clinical outcomes and prognostic factors predicting mortality. Medicine (Baltimore) 2022; 101:e29342. [PMID: 35945735 PMCID: PMC9351940 DOI: 10.1097/md.0000000000029342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We evaluated clinical outcome and prognostic factors predicting mortality of transcatheter arterial embolization (TAE) for acute gastrointestinal (GI) bleeding. Fifty-nine patients (42 men, 17 women; mean age 66.1 ± 17.0) who underwent 59 TAE procedures for GI bleeding during 2013-2018 were retrospectively evaluated. Clinical outcomes included technical success, adverse events, and rebleeding and mortality rate within 30 days. The technical success rate was 100%. Angiography showed contrast extravasation in 41 (69.5%) patients and indirect signs of bleeding in 16 (27.1%) patients. Two (3.4%) patients underwent prophylactic embolization. TAE-related adverse events occurred in 7 (11.9%) patients; adverse events were more common for mid GI or lower GI bleeding than for upper GI bleeding (22.6% vs 0%, P = 0.007). Rebleeding within 30 days was observed in 22 (37.3%) patients after TAE. Coagulopathy was a prognostic factor for rebleeding (odds ratio [OR] = 3.53, 95% confidence interval 1.07-11.67, P = .038). Mortality within 30 days occurred in 11 (18.6%) patients. Coagulopathy (OR = 24, 95% confidence interval 2.56-225.32, P = .005) was an independent prognostic factor for mortality within 30 days. TAE is an effective, safe, and potentially lifesaving procedure for GI bleeding. If possible, coagulopathy should be corrected before TAE as it may reduce rebleeding and mortality.
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Affiliation(s)
- Shinhaeng Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Taehwan Kim
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seung Chul Han
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Haeyong Pak
- Institute of Health Insurance & Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Han Ho Jeon
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- *Correspondence: Han Ho Jeon, Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea, 100 Ilsan-ro, Ilsan-donggu, Goyang 10444, Korea (e-mail: )
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5
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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Nakano M, Takano K, Kaga A, Tsujibayashi K, Kitajima Y, Sato H. The utility of using TACE-assisted software with CBCT in colonic diverticular bleeding without extravascular leakage. Radiol Phys Technol 2022; 15:177-186. [PMID: 35507125 DOI: 10.1007/s12194-022-00658-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
The utility of three-dimensional (3D) imaging with cone-beam computed tomography (CBCT) during interventional radiology (IVR) in colonic diverticular bleeding was compared to that of contrast-enhanced computed tomography (CECT). Additionally, to identify the responsible vessels in the absence of extravascular leakage using digital subtraction angiography, we examined the detection rate using software conventionally applied to transcatheter arterial chemoembolization (TACE). The 3D images obtained by CECT before IVR did not clearly show the destroyed vessels, whereas the 3D images obtained by CBCT during IVR clearly depicted the peripheral vessels. The TACE-assisted software identified the responsible vessels with a high probability, even in cases without extravascular leakage. CBCT could delineate vascular positions more accurately than CECT. Moreover, 80% of the responsible vessels could be delineated using the software; however, caution should be exercised as results may differ depending on the positioning of the region of interest.
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Affiliation(s)
- Masahiro Nakano
- Department of Radiological Technology, Kainan Hospital, Aichi Prefectrural Welfare Federation of Agricultural Cooperatives, 396 Minami-honden, Maegasu-cho, Yatomi-shi, Aichi, 498-8502, Japan.
| | - Kazuki Takano
- School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuro Kaga
- Department of Gastroenterology, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minami-honden, Maegasu-cho, Yatomi-shi, Aichi, 498-8502, Japan
| | - Keisuke Tsujibayashi
- Department of Radiological Technology, Kainan Hospital, Aichi Prefectrural Welfare Federation of Agricultural Cooperatives, 396 Minami-honden, Maegasu-cho, Yatomi-shi, Aichi, 498-8502, Japan
| | - Yukiya Kitajima
- Department of Radiological Technology, Kainan Hospital, Aichi Prefectrural Welfare Federation of Agricultural Cooperatives, 396 Minami-honden, Maegasu-cho, Yatomi-shi, Aichi, 498-8502, Japan
| | - Hiroaki Sato
- Department of Radiological Technology, Kainan Hospital, Aichi Prefectrural Welfare Federation of Agricultural Cooperatives, 396 Minami-honden, Maegasu-cho, Yatomi-shi, Aichi, 498-8502, Japan
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Yu H, Mei J, Qin L, Jia Z. Angiography findings and endovascular management of acute nonvariceal gastrointestinal bleeding: A pictorial essay. J Interv Med 2022; 5:1-5. [PMID: 35586279 PMCID: PMC8947995 DOI: 10.1016/j.jimed.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/26/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Patients with acute nonvariceal gastrointestinal bleeding (GIB) not treatable via endoscopic therapy require angiography and endovascular management. If the source of the bleeding can be identified on angiography, the bleeding can be controlled with minimal complications by endovascular treatments such as intra-arterial infusion of vasopressin, embolization, covered stent placement, or a combination thereof. This pictorial essay reviews the angiographic findings for and the endovascular management of acute nonvariceal GIB.
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Fontana F, Piacentino F, Ossola C, Coppola A, Curti M, Macchi E, De Marchi G, Floridi C, Ierardi AM, Carrafiello G, Segato S, Carcano G, Venturini M. Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature. J Clin Med 2021; 10:jcm10214979. [PMID: 34768505 PMCID: PMC8584454 DOI: 10.3390/jcm10214979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Christian Ossola
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
- Correspondence: ; Tel.: +39-0332-393609
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Marco Curti
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Chiara Floridi
- Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60100 Ancona, Italy;
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
| | - Sergio Segato
- Gastroenterology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy;
| | - Giulio Carcano
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
- Surgery Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
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Westrich D, Hachem C, Boumitri C. Iron Deficiency and the Small bowel. Curr Gastroenterol Rep 2021; 23:12. [PMID: 34236539 DOI: 10.1007/s11894-021-00812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article reviews iron deficiency anemia (IDA) and suspected small bowel bleeding (SSBB) from initial consultation through laboratory evaluation, endoscopic evaluation, and therapeutic options. RECENT FINDINGS Recent guidelines on management of SSBB, IDA, video capsule endoscopy (VCE), and device-assisted enteroscopy (DAE) are reviewed. The advantages and limitations of VCE, DAE, and imaging are discussed. Medical treatment for refractory small bowel bleeding is discussed. Evaluation of IDA starts with a detailed history and physical exam. Additional lab work can establish the diagnosis of IDA and evaluate for associated conditions. If initial endoscopic tests are unrevealing, SSBB should be ruled out. Further investigation can be performed using video capsule endoscopy (VCE), device-assisted enteroscopy (DAE), and imaging. The mainstay of medical treatment of IDA secondary to SSBB is iron supplementation. Additional treatment is tailored to the pathology and may include medical, endoscopic and surgical options.
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Affiliation(s)
- David Westrich
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Christine Hachem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Christine Boumitri
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA.
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Park S, Jeong B, Shin JH, Jang EH, Hwang JH, Kim JH. Transarterial embolisation for gastroduodenal bleeding following endoscopic resection. Br J Radiol 2021; 94:20210062. [PMID: 33861138 DOI: 10.1259/bjr.20210062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. METHODS Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. RESULTS Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. CONCLUSIONS TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. ADVANCES IN KNOWLEDGE This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.
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Affiliation(s)
- Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, Republic of Korea
| | - Jung Han Hwang
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
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Yu J, Jung J, Park SR, Ryu MH, Park JH, Kim JH, Yoon SM. Role of palliative radiotherapy in bleeding control in patients with unresectable advanced gastric cancer. BMC Cancer 2021; 21:413. [PMID: 33858353 PMCID: PMC8048171 DOI: 10.1186/s12885-021-08145-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background This study analyzed the clinical results of palliative radiotherapy for bleeding control in patients with unresectable advanced gastric cancer. Methods We retrospectively reviewed the medical records of patients who met the following inclusion criteria between January 2002 and June 2018: histologically proven gastric cancer, gastric tumor bleeding confirmed by upper gastrointestinal endoscopy, and palliative radiotherapy performed for hemostasis. The median radiotherapy dose was 30 Gy, with a daily dose ranging from 1.8 to 3 Gy. Results Sixty-one patients were included in this analysis. The study population was predominantly male (72.1%), with a median age of 62 years (range: 32–92). The median baseline hemoglobin level was 7.1 g/dL, and the most common presenting symptom of gastric tumor bleeding was melena (85.2%). Bleeding control was achieved in 54 (88.5%) patients. The median levels of hemoglobin at 1, 2, and 3 months after completion of radiotherapy were 10.1 g/dL, 10.2 g/dL, and 10.4 g/dL, respectively; these values were significantly different from that before radiotherapy (7.1 g/dL; p < 0.001). The median overall survival was 4.8 months. Among the 54 patients who achieved bleeding control after radiotherapy, 19 (35.2%) experienced re-bleeding during the follow-up period. The median time to re-bleeding was 6.0 months. Multivariate analysis demonstrated that a higher radiation dose (p = 0.007) and additional chemotherapy after radiotherapy (p = 0.004) were significant factors for prolonging the time to re-bleeding. Conclusions Tumor bleeding was adequately controlled by radiotherapy in patients with unresectable advanced gastric cancer.
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Affiliation(s)
- Jesang Yu
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Pech M, Serafin Z, Fischbach F, Damm R, Jargiełło T, Seidensticker M, Powerski M. Transarterial embolization of acute iatrogenic hemorrhages: predictive factors for mortality and outcome. Br J Radiol 2020; 93:20190413. [PMID: 32142365 PMCID: PMC10993211 DOI: 10.1259/bjr.20190413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Iatrogenic hemorrhages occur in 0.5-16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome. METHODS All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality. RESULTS A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% vs 15%, p < 0.05). CONCLUSION Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention. ADVANCES IN KNOWLEDGE This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.
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Affiliation(s)
- Maciej Pech
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
- Department of Radiology, Medical University of
Gdańsk, Gdańsk,
Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus
Copernicus University, Bydgoszcz,
Poland
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology,
Medical University of Lublin,
Lublin, Poland
| | - Max Seidensticker
- Department of Radiology, University Hospital
Munich, Munich,
Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
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13
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Alghamdi T. Angiodysplasia in terminal ileum: Case report and review of literature. Int J Surg Case Rep 2019; 66:165-168. [PMID: 31862659 PMCID: PMC6926272 DOI: 10.1016/j.ijscr.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Angiodysplasia is the second most common vascular abnormality of the GI tract after diverticulosis and is the second principal cause of lower GI bleeding over 60 years. CASE REPORT A 68-year-old male patient presented to our institute in the outpatient clinic with pallor of gradual onset and progressive course since 6 months. Detailed history revealed hematochezia, sometimes melena. Physical examination revealed signs of iron deficiency anemia which was confirmed by laboratory results and hemoccult positive stool. The patient refused the colonoscopy. A bdominal CT with contrast was then performed which revealed an evidence of abnormal subtle mural contrast flocculation within the small bowel loop with luminal extravasations of contrast at small segment of distal ileum few centimeters from ileocaecal valve with mildly dilated and early filling of its drained vein, this abnormal contrast extravasations and flocculation increased through dynamic study. In addition, evidence of contrast mural flocculation within the left lateral wall of distal few centimeters of rectum was also observed. This abnormal mural contrast flocculation within the wall of solitary segment terminal ileum and distal rectum suggest the evidence of venous ectasia or angiodysplasia. Surgical resection was done with end to end anastomosis of the small intestine without any complication in the postoperative progress. CONCLUSION This case also emphasizes the critical significance of a mutual multidisciplinary approach to occult gastrointestinal bleeding. The management of angiodysplasia is considered as multidisciplinary team work that would consist of expertise from different departments as in endoscopy, angiography, and gastrointestinal surgery.
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Affiliation(s)
- Thamer Alghamdi
- Albaha University, Faculty of Medicine, Surgery Department, Albaha Governorance, 1988, Saudi Arabia.
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14
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Carney BW, Khatri G, Shenoy-Bhangle AS. The role of imaging in gastrointestinal bleed. Cardiovasc Diagn Ther 2019; 9:S88-S96. [PMID: 31559156 DOI: 10.21037/cdt.2018.12.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gastrointestinal (GI) bleed accounts for approximately 20% of emergency visits; 2% of hospital admissions and its incidence has been increasing. In patients where the GI bleed does not stop spontaneously, intervention is required to identify the source of bleeding and stop the hemorrhage. Although identifying the source of bleeding can be challenging due to the vast number of underlying etiologies, radiology plays a vital role in patients where endoscopy and/or medical management fail. Radiology offers both non-invasive and invasive options for the diagnosis as well as management of GI bleeds. Scintigraphy and computed tomography angiography (CTA) are the most important non-invasive imaging tests that can identify presence of and help locate the site of bleeding and are used when the patient is hemodynamically stable. If the patient is hemodynamically unstable, conventional angiography (CA) allows diagnosis of the presence, site of bleeding as well as the means of treating the bleed by embolization. Our review article focuses on the various etiologies of GI bleed, the role of imaging in diagnosis as well as treatment of these patients based on the underlying etiologies, the merits and disadvantages of each of these modalities with emphasis on triaging patients for the most appropriate imaging test to guide the most suitable management.
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Affiliation(s)
| | - Garvit Khatri
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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15
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Parra-Fariñas C, Quiroga-Gomez S, Castro-Boix S, Vallribera-Valls F, Castellà-Fierro E. Computed tomography of complicated Meckel's diverticulum in adults. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Tomografía computarizada del divertículo de Meckel complicado en adultos. RADIOLOGIA 2019; 61:297-305. [DOI: 10.1016/j.rx.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/15/2018] [Accepted: 10/21/2018] [Indexed: 11/21/2022]
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17
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Ye T, Yang L, Wang Q, Liu J, Zhou C, Zheng C, Xiong B. Analysis of negative DSA findings in patients with acute nonvariceal gastrointestinal bleeding: A retrospective study of 133 patients. J Interv Med 2019; 2:27-30. [PMID: 34805866 PMCID: PMC8562268 DOI: 10.1016/j.jimed.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To analyze causes of acute nonvariceal gastrointestinal bleeding (GIB) with negative digital subtraction angiography (DSA) results. Materials and methods The clinical and follow-up data of 133 patients - recruited between February 2008 and November 2016 - with acute nonvariceal GIB and negative DSA results were included in this study. DSA results, diagnoses, and clinical outcomes were recorded. Results The DSA results were negative in all 133 patients. Of the total, 55 patients (41.4%) chose to undergo surgery and 78 (58.6%) opted for conservative treatment. Within 30 days, there was no significant difference in the rebleeding or mortality rates between the two groups (P < .05). Of all 133 patients, 76 (57.1%) had upper GIB and 57 (42.9%) had lower GIB; within 30 days, the rebleeding rate in the upper GIB group (44.7%, 34/76) was significantly higher than that in the lower GIB group (26.3%, 15/57). There was no significant statistical difference (P < .05) within 30 days in the mortality rates between the two groups. Among patients with upper GIB, 26 (34.2%, 26/76) opted to undergo surgery and 50 (65.8%, 50/76) chose conservative treatment; within 30 days, the rebleeding rate in the group that chose surgery (61.5%, 16/26) was higher than that in the conservative treatment group (36%, 18/50). There was no significant difference (P < .05) within 30 days in the mortality rate between the two groups. Among the patients with lower GIB, 29 (50.9%, 29/57) chose to undergo surgery and 28 (49.1%, 28/57) opted for conservative treatment. Within 30 days, the rebleeding rate in the surgery group (13.8%, 4/29) was lower than that in conservative treatment group (39.3%, 11/28). There was no significant difference (P < .05) within 30 days in the mortality rate between the two groups. Sixteen patients underwent prophylactic arterial embolization; in 6 of these, bleeding was stopped for 30 days. DSA was then repeated in these 16 patients after a median interval of 1 day, and a positive bleeding site was found in 9 of the 16. Causes of bleeding were found in 111 patients by surgery or endoscopy, whereas the causes remained unknown in 22 patients. Conclusions Upper GIB with negative DSA results was stopped by conservative treatment, whereas lower GIB required surgery to detect the culprit bleeding site. Rare causes of GIB should be considered and appropriate management selected in a timely manner in order to detect unusual causes.
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Noh SM, Shin JH, Kim HI, Lee SH, Chang K, Song EM, Hwang SW, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. [Clinical Outcomes of Angiography and Transcatheter Arterial Embolization for Acute Gastrointestinal Bleeding: Analyses according to Bleeding Sites and Embolization Types]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:219-228. [PMID: 29684971 DOI: 10.4166/kjg.2018.71.4.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background/Aims The clinical outcomes of angiography and transcatheter arterial embolization (TAE) for acute gastrointestinal bleeding (GIB) have not been completely assessed, especially according to bleeding sites. This study aimed to assess the efficacy of angiography and safety of TAE in acute GIB. Methods This was a retrospective study evaluating the records of 321 patients with acute GIB who underwent angiography with or without TAE. Targeted TAE was conducted in 134 patients, in whom angiography showed bleeding sources. Prophylactic TAE was performed in 29 patients when the bleeding source was not detected but a specific vessel was strongly suspected by other examinations. The rate of technical success, clinical success, and complications were analyzed. Results The detection rate of bleeding source via angiography was 50.8% (163/321), which was not different according to the bleeding sites. The detection rate was higher if the probable bleeding source had already been found by another investigation (59.7% vs. 35.8%, p<0.001). TAE sites were upper GIB in 67, mid GIB in 74, and lower GIB in 22. The technical success rate was 99.3% (133/134), and the clinical success rate was 63.0% (104/163). The prophylactic embolization group showed lower clinical success rate than the targeted embolization group (44.8% vs. 67.9%, p=0.06). The TAE-related complication rate was 12.9% (21/163). Ischemia and/or infarction was more common after TAE for mid and lower GIB than for upper GIB (15.6% vs. 3.0%, p=0.007). Conclusions Angiography with or without TAE was an effective method for acute GIB. Targeted embolization should be performed if possible given that it has a higher clinical success rate.
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Affiliation(s)
- Soo Min Noh
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Departments of Internal Medicine and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Il Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ho Lee
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kiju Chang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Yang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jae Myung
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Kyun Yang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Sik Byeon
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Griessner H, Kunit T, Colleselli D, Drerup M, Oberhammer L, Wolfgruber T, Lusuardi L, Mitterberger M. Pseudoaneurysma der bulbären Harnröhre nach traumatischer Katheterisierung. Urologe A 2018; 57:1357-1359. [DOI: 10.1007/s00120-018-0665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Powerski M, Meyer-Wilmes P, Omari J, Damm R, Seidensticker M, Friebe B, Fischbach F, Pech M. Transcatheter arterial embolization of acute bleeding as 24/7 service: predictors of outcome and mortality. Br J Radiol 2018; 91:20180516. [PMID: 30102552 DOI: 10.1259/bjr.20180516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To analyze times of occurrence and identify risk factors (RFs) for technical and clinical failure and mortality of transcatheter arterial embolization (TAE) of acute bleeding in a major hospital. METHODS All TAEs performed at our hospital from 2006 to 2013 (n = 327) were retrospectively analyzed. RESULTS TAEs were performed during regular weekday hours in 165 (50%) and during off-hours in 162 (50%) cases. With 40 regular and 128 off-hours/week, 3.25 times more TAEs were performed during regular hours. There was an even distribution across weekdays (Mon-Fri:16.9 ± 1.5%), while fewer TAEs were performed on weekends (Sat: 8.3%, Sun: 7.3%). Technical success of TAEs was 93.9% with a clinical success of 79.2% and a 30-day mortality of 18.4%. Shock was an RF for technical failure (p = 0.022). RFs for clinical failure were low hemoglobin (Hb) (p = 0.021) and transfusion of ≥6 units packed cells (p = 0.009). Independent RFs for mortality were clinical failure (p < 0.001), coagulopathy (p = 0.005), and shock (p < 0.001). CONCLUSION Our results provide no evidence for a subjectively perceived increase in TAEs during off-hours but rather appear to show that most TAEs are performed during regular hours. Prompt TAE to control acute bleeding is crucial to prevent a drop in Hb with shock and the need for transfusion, which may promote coagulopathy and rebleeding, all of which are risk factors for a negative outcome. ADVANCES IN KNOWLEDGE The presented analysis provides insights of occurrences and risk factors for success of transcatheter arterial embolization in acute bleeding in a large study population.
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Affiliation(s)
- Maciej Powerski
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Philipp Meyer-Wilmes
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Jazan Omari
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Robert Damm
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Max Seidensticker
- 2 Klinik und Poliklinik für Radiologie, Klinikum der Universität München , München , Germany
| | - Björn Friebe
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Frank Fischbach
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany
| | - Maciej Pech
- 1 Department of Radiology and Nuclear Medicine, Otto-von-Guericke University , Magdeburg , Germany.,3 Department of Radiology, Medical University of Gdansk , Gdańsk , Poland
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21
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Morrison TC, Wells M, Fidler JL, Soto JA. Imaging Workup of Acute and Occult Lower Gastrointestinal Bleeding. Radiol Clin North Am 2018; 56:791-804. [PMID: 30119774 DOI: 10.1016/j.rcl.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lower gastrointestinal bleeding is defined as occurring distal to the ligament of Treitz and presents as hematochezia, melena, or with anemia and positive fecal occult blood test. Imaging plays a pivotal role in the localization and treatment of lower gastrointestinal bleeds. Imaging tests in the workup of acute lower gastrointestinal bleeding include computed tomography (CT) angiography, nuclear medicine scintigraphy, and conventional catheter angiography. Catheter angiography can also be used to deliver treatment. Imaging tests in the workup of occult lower gastrointestinal bleeding include CT enterography and nuclear medicine Meckel scan.
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Affiliation(s)
- Trevor C Morrison
- Boston University Medical Center, 830 Harrison Avenue, FGH 3rd Floor, Boston, MA 02118, USA
| | - Michael Wells
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jorge A Soto
- Boston University Medical Center, 830 Harrison Avenue, FGH 3rd Floor, Boston, MA 02118, USA.
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22
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Nykänen T, Peltola E, Kylänpää L, Udd M. Transcatheter Arterial Embolization in Lower Gastrointestinal Bleeding: Ischemia Remains a Concern Even with a Superselective Approach. J Gastrointest Surg 2018; 22:1394-1403. [PMID: 29549618 DOI: 10.1007/s11605-018-3728-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/22/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB). METHODS Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004-2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates (≤ 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival. RESULTS During the study period, angiography for LGIB was necessary on 123 patients. Out of 123, 55 (45%) underwent embolization attempts. TAE was technically successful in 53 (96%). Rebleeding occurred in 14 (26%). The complication rate was 36%, minor complications occurring in 10 (19%) and major in nine (17%). Major complications resulted in bowel resection in seven (13%). Post embolization ischemia was the most common single complication seen in nine (17%). The mortality rate was 6%. Survival estimates of 1 and 5 years were 79 and 49%. DISCUSSION LGIB is a severe physiological insult occurring in patients who are often elderly and moribund. Although major post embolization complications occur, transcatheter arterial embolization should be the first-line approach over surgery in profuse LGIB in patients with hemodynamic instability, when colonoscopy fails or is unavailable, or when computerized tomography angiography detects small intestinal bleeding.
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Affiliation(s)
- Taina Nykänen
- Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland.
| | - Erno Peltola
- Helsinki University Hospital, Helsinki Medical Imaging Center, Helsinki, Finland
| | - Leena Kylänpää
- Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland
| | - Marianne Udd
- Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland
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Orron DE, Bloom AI, Neeman Z. The Role of Transcatheter Arterial Embolization in the Management of Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2018; 28:331-349. [PMID: 29933779 DOI: 10.1016/j.giec.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nearly 50 years ago, catheter angiography was introduced as a means of both diagnosing and treating nonvariceal upper gastrointestinal bleeding. Technological advances and innovations have resulted in the introduction of microcatheters that, using a coaxial technique, are capable of selecting third-order arterial branches and of delivering a wide array of embolic agents. This article reviews the imaging diagnosis of nonvariceal upper gastrointestinal bleeding, the techniques of diagnostic and therapeutic angiography, the angiographic appearance of the various etiologies of nonvariceal upper gastrointestinal bleeding, the rationale behind case-specific selection of embolic agents as well as the anticipated outcome of transcatheter arterial embolization.
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Affiliation(s)
- Dan E Orron
- Department of Radiology, Carmel Medical Center, Michal Street, Haifa 34362, Israel
| | - Allan I Bloom
- Department of Radiology, Hadassah University Medical Center, Ein Karem, Jerusalem 91120, Israel
| | - Ziv Neeman
- Medical Imaging Institute, Haemek Medical Center, Izhak Rabin Boulevard, Afula 1834111, Israel.
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Morris CS. Invited Commentary on “CT for Evaluation of Acute Gastrointestinal Bleeding”. Radiographics 2018; 38:1108-1110. [DOI: 10.1148/rg.2018180132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher Scott Morris
- Department of Radiology, Larner College of Medicine at the University of Vermont Burlington, Vermont
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Chetcuti Zammit S, Koulaouzidis A, Sanders DS, McAlindon ME, Rondonotti E, Yung DE, Sidhu R. Overview of small bowel angioectasias: clinical presentation and treatment options. Expert Rev Gastroenterol Hepatol 2018; 12:125-139. [PMID: 28994309 DOI: 10.1080/17474124.2018.1390429] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Elderly patients with multiple co-morbidities are at an increased risk of developing small bowel angioectasias. Treating these lesions can be both challenging and costly with patients requiring extensive investigations and recurrent admissions for iron infusions and blood transfusions as well as invasive procedures. This review presents treatment options and describes in detail drugs that should be considered whilst taking into account their effectiveness and their safety profile. Areas covered: A PubMed search was carried out using the following keywords: small bowel angiodysplasias, small bowel angioectasias, small bowel bleeding and obscure gastrointestinal bleeding to assess existing evidence. The pathophysiology and risk factors are covered in this review together with appropriate methods of investigation and management. Treatment options discussed are endoscopic measures, surgical options and pharmacotherapy. The role of serum biomarkers is also discussed. Expert commentary: Future work should be directed at alternative drugs with a good safety profile that target biomarkers. Novel pharmacotherapy directed at biomarkers could potentially provide a non-invasive treatment option for angioectasias particularly in the elderly where management can be challenging.
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Affiliation(s)
| | | | - David S Sanders
- a Gastroenterology Department , Royal Hallamshire Hospital , Sheffield , UK
| | - Mark E McAlindon
- a Gastroenterology Department , Royal Hallamshire Hospital , Sheffield , UK
| | | | - Diana E Yung
- b Endoscopy Unit , the Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Reena Sidhu
- a Gastroenterology Department , Royal Hallamshire Hospital , Sheffield , UK
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Shabunin AV, Bagateliya ZA, Korzheva IY, Lebedev SS. [Urgent surgical care for patients with colon cancer complicated by hemorrhage]. Khirurgiia (Mosk) 2017:46-51. [PMID: 29286030 DOI: 10.17116/hirurgia20171246-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM To evaluate an effectiveness of various hemostatic methods in patients with colon and rectal cancer. MATERIAL AND METHODS 77 urgent patients with colon and rectal cancer complicated by bleeding were enrolled. Medication was effective in 11 patients (group 1), endoscopic hemostasis in 47 patients (group 2), vascular embolization in 2 cases (group 3), internal iliac arteries ligation in 2 patients (group 4), 15 patients underwent emergency resection (group 5). Twenty out of 62 patients in groups 1-4 underwent elective radical procedures and radio- or chemotherapy in 7-10 days after hemostasis and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group 5) and elective surgery (groups 1-4) in 31 patients. RESULTS Effectiveness of various hemostatic methods was 14.3% in group 1, 79.7% in group 2, 28.6% in group 3 and 100% in groups 4 and 5. Postoperative morbidity and mortality were higher after emergency (group 5) compared with elective (groups 1-4) procedures: 33.3 and 20%; 15 and 5% respectively. 3-year survival was better after elective than emergency operations - 0.78 and 0.57, respectively. CONCLUSION Management of bleeding should be carried out by highly qualified specialist at multi-field emergency care hospital. Endoscopy and arterial embolization are the most effective methods of hemostasis with minimal risk of complications. In hemorrhage patients endoscopy and embolization ("bridge to surgery") are an alternative to conditionally radical operations, since they allow to reduce mortality.
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Affiliation(s)
- A V Shabunin
- Department of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow; Botkin City Clinical Hospital of Moscow Healthcare Departmant, Moscow, Russia
| | - Z A Bagateliya
- Department of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow; Botkin City Clinical Hospital of Moscow Healthcare Departmant, Moscow, Russia
| | - I Yu Korzheva
- Department of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow; Botkin City Clinical Hospital of Moscow Healthcare Departmant, Moscow, Russia
| | - S S Lebedev
- Department of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow; Botkin City Clinical Hospital of Moscow Healthcare Departmant, Moscow, Russia
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A Novel Technique to Measure the Intensity of Abnormality on GI Bleeding Scans: Development, Initial Implementation, and Correlation With Conventional Angiography. Clin Nucl Med 2017; 43:82-86. [PMID: 29215411 DOI: 10.1097/rlu.0000000000001920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Develop a technique to quantify intensity of lower gastrointestinal bleeding (LGIB) on Tc-labeled red blood cell (RBC) scintigraphy, correlate with angiography, and determine the tool's predictive value. MATERIALS AND METHODS An IRB-approved, single institution database query of GI bleeding scans performed between January 2013 and December 2015. Reports from all studies and imaging from all positive studies were reviewed. A technique was developed for scan analysis, allowing for calculation of percent increase of activity in the region of interest (ROI, area of bleeding) and ROI in the aorta and liver (controls). Database query determined which patients underwent angiography, and which had positive angiograms. Median ROI percent increase in patients with positive scintigraphy and positive angiography was compared to those with positive scintigraphy and negative angiography. RESULTS Of 194 bleeding scans performed during the study period, 71 were positive for active LGIB, 37 had angiography, and 9 had active contrast extravasation. The new tool was used to analyze the 37 cases with positive nuclear scans sent for angiography. Median percent increase in ROI activity was 50% in those with positive scan and positive angiogram and 26.8% in those with positive scan but negative angiogram. Using ROI percent change quartiles, we observed a statistically significant association between percent increase in ROI activity from baseline and the probability of having a positive angiogram (Cochran-Armitage trend test, P = 0.01), such that there are no positive angiogram cases when ROI change was <20% and a majority of the positive angiogram cases (67%) in the highest quartile. CONCLUSIONS Utilization of processing protocol to determine percent increase in activity from baseline within ROI of active LGIB on scintigraphy has predictive value in determining which patients will not benefit from conventional angiography.
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Shi ZX, Yang J, Liang HW, Cai ZH, Bai B. Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine (Baltimore) 2017; 96:e9437. [PMID: 29384923 PMCID: PMC6392562 DOI: 10.1097/md.0000000000009437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc., were used to embolize the targeted vessels. The angiographic manifestations and the effects of embolization of acute arterial massive hemorrhage of the GI tract were retrospectively analyzed.Of the 88 patients, 54 were diagnosed with arterial hemorrhage of the upper GI tract and 34 with arterial hemorrhage of the lower GI tract. Eighty cases were associated with positive angiography, which showed the following: contrast extravasation (only); gastroduodenal artery stenosis; pseudoaneurysm (only); pseudoaneurysm rupture with contrast extravasation; pseudoaneurysms merged with intestinal artery stenosis; GI angiodysplasia; and tumor vascular bleeding. Eight cases were diagnosed with negative angiography. Seven-two patients underwent successful hemostasis, and a total of 81 arteries were embolized. The technical and clinical success rates (no rebleeding within 30 days) in performing transcatheter embolization on patients with active bleeding were 100% and 84.71%, respectively (72 of 85). Within 30 days, the postoperative rebleeding rate was 15.29% (13/85). Of these rebleeding cases, 2 patients were formerly treated with "blind embolization," 7 underwent interventional embolic retreatment, and 3 had surgical operations. All cases were followed-up for 1 month, and 3 patients died from multiple organ failure. No serious complications such as bowel ischemia necrosis were observed.ETAE is a safe, effective, and minimally invasive treatment; because of the diversified arteriographic manifestations of acute GI hemorrhage, the proper selection of embolic agents and the choice of reasonable embolization method are essential for successful hemostasis.
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Affiliation(s)
| | - Jing Yang
- Department of Interventional Radiology
| | | | - Zhen Hua Cai
- Department of Pain, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Bin Bai
- Department of Interventional Radiology
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Werner DJ, Manner H, Nguyen-Tat M, Kloeckner R, Kiesslich R, Abusalim N, Rey JW. Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature. United European Gastroenterol J 2017; 6:337-342. [PMID: 29774146 DOI: 10.1177/2050640617746299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
Abstract
Lower gastrointestinal bleeding is common and occurs often in elderly patients. In rare cases it is associated with hemorrhagic shock. A large number of such bleedings, which are often caused by colon diverticula, subside spontaneously. Alternatively they can be treated by endoscopic procedures successfully. Given the aging population of our society, the rising incidence of lower gastrointestinal tract bleeding and new anticoagulant therapies, some of the bleedings tend to be severe. Colonoscopy is the established standard procedure for the diagnosis and treatment of lower gastrointestinal bleeding. However, a small number of patients experience re-bleeding or shock; their bleeding does not resolve spontaneously and cannot be treated successfully by endoscopic procedures. In such patients, interventional radiology is very useful for the detection of bleeding and the achievement of hemostasis. Against this background we performed a literature search using PubMed to identify all relevant studies focused on the endoscopic and radiological management of lower gastrointestinal bleeding and present recent conclusions on the subject.
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Affiliation(s)
- David J Werner
- RNS Joint Practice, Department of Radiology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Hendrik Manner
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Marc Nguyen-Tat
- First Department of Internal Medicine, University Medical Center, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Germany
| | - Ralf Kiesslich
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Nael Abusalim
- RNS Joint Practice, Department of Radiology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Johannes W Rey
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
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Konecki D, Grabowska-Derlatka L, Pacho R, Rowiński O. Correlation Between Findings of Multislice Helical Computed Tomography (CT), Endoscopic Examinations, Endovascular Procedures, and Surgery in Patients with Symptoms of Acute Gastrointestinal Bleeding. Pol J Radiol 2017; 82:676-684. [PMID: 29662594 PMCID: PMC5894035 DOI: 10.12659/pjr.902331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. Material/Methods The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. Results The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. Conclusions CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.
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Affiliation(s)
- Dariusz Konecki
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Ryszard Pacho
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
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Shabunin AV, Bagateliya ZA, Korzheva IY, Lebedev SS. [Urgent surgical care for patients with colon cancer complicated by hemorrhage]. Khirurgiia (Mosk) 2017:18-24. [PMID: 29076478 DOI: 10.17116/hirurgia20171018-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM Comparative evaluation of the effectiveness of various hemostatic methods in patients with colon and rectal cancer complicated by bleeding. MATERIAL AND METHODS We examined 77 hospitalized patients with colon and rectal cancer complicated by bleeding. Conservative therapy was effective in 11 patients (group I), endoscopic hemostasis in 49 cases (group II), 17 patients underwent emergency surgery (bowel resection/ internal iliac arteries ligation) (group III). Vascular embolization was performed in 2 patients. 20 out of 77 patients in groups I-II underwent elective surgery and radiochemotherapy in 7-10 days after hemorrhage and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group III) and elective (I-II) interventions in 37 survivors. RESULTS The effectiveness of various methods of hemostasis was 14.3% in group I, 80.3% in group II and 100% in group III. Embolization was ineffective (patients underwent surgery). Complications were observed in 4.9% (II) and 29.4% (III), respectively. Mortality was significantly higher after conditionally radical surgery than after endoscopy: 17.6% vs. 0. 3-year survival was better after elective interventions compared with emergency surgery (0.79 vs. 0.64, respectively). CONCLUSION Endoscopy is the most effective method to stop colonic bleeding with minimal complications. It is a 'bridge to surgery' and alternative to conditionally radical operations in order to reduce mortality. Treatment of bleeding should be carried out in multi-field hospital by highly qualified specialists.
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Affiliation(s)
- A V Shabunin
- Chair of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
| | - Z A Bagateliya
- Chair of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
| | - I Yu Korzheva
- Chair of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
| | - S S Lebedev
- Chair of Surgery of the Russian Medical Academy of Postgraduate Education of Healthcare Ministry of the Russian Federation, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
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Sağlam D, Dinç H, Gündüz A, Cansu A, Öztürk MH. Endovascular embolization in the management of traumatic and postoperative abdominopelvic bleeding: a single-center experience. Turk J Med Sci 2017; 47:1144-1151. [PMID: 29156854 DOI: 10.3906/sag-1603-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Endovascular embolization is widely used instead of surgery in the treatment of traumatic and postoperative abdominopelvic bleeding. The objective of this study is to evaluate the efficiency of computed tomography in the determination of active bleeding and the efficiency of endovascular embolization in traumatic and postoperative abdominopelvic bleeding. Materials and methods: Thirty-one patients admitted to our hospital with traumatic and postoperative abdominopelvic bleeding between January 2006 and September 2012 and treated with endovascular embolization were retrospectively enrolled in the study. In 15 hemodynamically stable patients, abdominal computed tomography was performed to detect the presence and/or localization of the hemorrhage. All 31 patients underwent digital subtraction angiography (DSA) and endovascular embolization. Results: Active hemorrhage was detected in all patients evaluated by computed tomography. Thirty-two embolization procedures were performed in 31 patients. Embolization was successful in all procedures. Two patients needed retreatment because of recurrent bleeding. One patient died 2 days after embolization as a result of concomitant multiorgan injury. Conclusion: Computed tomography is able to detect active bleeding, allowing it to take the place of diagnostic DSA. If careful patient selection is carried out, endovascular embolization may be the final treatment, despite high-grade visceral organ injury.
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ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding. J Am Coll Radiol 2017; 14:S177-S188. [PMID: 28473074 DOI: 10.1016/j.jacr.2017.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/18/2022]
Abstract
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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Ray DM, Srinivasan I, Tang SJ, Vilmann AS, Vilmann P, McCowan TC, Patel AM. Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology. World J Radiol 2017; 9:97-111. [PMID: 28396724 PMCID: PMC5368632 DOI: 10.4329/wjr.v9.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/12/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.
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Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Najran PS, Wilson M, Mullan D. Coil occlusion of anal cushions in severe lower gastrointestinal haemorrhage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pavan Singh Najran
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Malcom Wilson
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Damian Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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Zheng L, Shin JH, Han K, Tsauo J, Yoon HK, Ko GY, Shin JS, Sung KB. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma. Cardiovasc Intervent Radiol 2016; 39:1564-1572. [PMID: 27435580 DOI: 10.1007/s00270-016-1422-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/07/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma. MATERIALS AND METHODS The medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively. RESULTS A total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1). CONCLUSION Angiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.
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Affiliation(s)
- Lin Zheng
- Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
| | - Kichang Han
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Jiaywei Tsauo
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Jong-Soo Shin
- Department of Radiology, Kyunghee University, College of Medicine, Kangdong Kyunghee University Hospital, Seoul, South Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
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Abusedera M, Ramzen M, Ebrahim W. Predictors of positive angiography and evaluation of the outcome of transcatheter control of non variceal upper gastrointestinal hemorrhage. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Moss AJ, Tuffaha H, Malik A. Lower GI bleeding: a review of current management, controversies and advances. Int J Colorectal Dis 2016; 31:175-88. [PMID: 26454431 DOI: 10.1007/s00384-015-2400-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Lower gastrointestinal (GI) bleeding is defined as bleeding distal to the ligament of Treitz. In the UK, it represents approximately 3 % of all surgical referrals to the hospital. This review aims to provide review of the current evidence regarding the management of this condition. METHODS Literature was searched using Medline, Pubmed, and Cochrane for relevant evidence by two researchers. This was conducted in a manner that enabled a narrative review of the evidence covering the aetiology, clinical assessment and management options of continuously bleeding patients. FINDINGS The majority of patients with acute lower GI bleeding can be treated conservatively. In cases where ongoing bleeding occurs, colonoscopy is still the first line of investigation and treatment. Failure of endoscopy and persistent instability warrant angiography, possibly preceded by CT angiography and proceeding to superselective embolisation. Failure of embolisation warrants surgical intervention. CONCLUSIONS There are still many unanswered questions. In particular, the development of a more reliable predictive tool for mortality, rebleeding and requirement for surgery needs to be the ultimate priority. There are a small number of encouraging developments on combination therapy with regard to angiography, endoscopy and surgery. Additionally, the increasing use of haemostatic agents provides an additional tool for the management of bleeding endoscopically in difficult situations.
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Affiliation(s)
- Andrew J Moss
- Department of Surgery, Peterborough City Hospital, Peterborough, Cambridgeshire, PE3 9GZ, UK
| | - Hussein Tuffaha
- Department of Surgery, Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK.
| | - Arshad Malik
- Department of Surgery, Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK
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Yu TT, Zhang HJ. Diagnosis and treatment of Crohn's disease complicated by massive lower gastrointestinal hemorrhage. Shijie Huaren Xiaohua Zazhi 2016; 24:242-247. [DOI: 10.11569/wcjd.v24.i2.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Crohn's Disease (CD) is a chronic granulomatous inflammatory disorder of the gastrointestinal tract. With the change of the life style and the progress of the diagnosis method, the number of patients diagnosed with CD has increased in China. In the course of disease development, some patients may have intestinal obstruction, abdominal abscess, acute perforation, gastrointestinal bleeding or other complications. Massive lower gastrointestinal hemorrhage is not a common complication of CD, and is a challenge for diagnosis and therapeutic management. It is more difficult to diagnose and treat CD associated lower digestive tract hemorrhage, compared with massive hemorrhage of lower digestive tract caused by other reasons. This paper reviews recent advances in the diagnosis and management of CD complicated with severe lower gastrointestinal hemorrhage.
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Chen JM, Lv J, Ma K, Yan J. Assessment of internal mammary artery injury after blunt chest trauma: a literature review. J Zhejiang Univ Sci B 2015; 15:864-9. [PMID: 25294375 DOI: 10.1631/jzus.b1400098] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The occurrence, bleeding, and treatment of internal mammary artery (IMA) injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.
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Affiliation(s)
- Jin-ming Chen
- Department of Emergency Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; Department of Emergency Medicine, Zhejiang Hospital, Hangzhou 310053, China; Department of Thoracic Surgery, the Affiliated Hospital, School of Medicine, Qingdao University, Qingdao 266003, China
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Angiographic Evaluation and Management of Nonvariceal Gastrointestinal Hemorrhage. AJR Am J Roentgenol 2015; 205:753-63. [DOI: 10.2214/ajr.15.14803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
PURPOSE OF REVIEW Acute, nonvariceal upper gastrointestinal bleeding (UGIB) is a common medical emergency encountered worldwide. Despite medical and technological advances, it remains associated with significant morbidity and mortality. RECENT FINDINGS Rapid patient assessment and management are paramount. When indicated, upper endoscopy in patients presenting with acute UGIB is effective for both diagnosis of the bleeding site and provision of endoscopic hemostasis. Endoscopic hemostasis significantly reduces rebleeding rates, blood transfusion requirements, length of hospital stay, surgery, and mortality. Furthermore, early upper endoscopy, defined as being performed within 24 h of patient presentation, improves patient outcomes. SUMMARY A structured approach to the patient with acute UGIB that includes early hemodynamic resuscitation and stabilization, preendoscopic risk stratification using validated instruments, pharmacologic and endoscopic intervention, and postendoscopy therapy is important to optimize patient outcome and assure efficient use of medical resources.
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Schlag C, Menzel C, Nennstiel S, Neu B, Phillip V, Schuster T, Schmid RM, von Delius S. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2015; 81:889-95. [PMID: 25432532 DOI: 10.1016/j.gie.2014.09.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND In mid-GI bleeding, video capsule endoscopy (VCE) shows the best diagnostic yield for ongoing overt bleeding. To date, the utility of VCE in acute severe GI bleeding has been analyzed rarely. OBJECTIVE To evaluate the impact of VCE when performed on patients with acute severe GI bleeding immediately after an initial negative upper endoscopy result. DESIGN Prospective study. SETTING Tertiary-care center. PATIENTS Patients with melena, dark-red or maroon stool, hemodynamic instability, drop of hemoglobin level ≥2 g/dL/day, and/or need of transfusion ≥2 units of packed red blood cells per day were included. INTERVENTIONS After a negative upper endoscopy result, emergency VCE was performed by immediate endoscopic placement of the video capsule into the duodenum. MAIN OUTCOME MEASUREMENTS Rate of patients in whom emergency VCE correctly guided further diagnostic and therapeutic procedures. RESULTS Upper endoscopy showed the source of bleeding in 68 of 88 patients (77%). In the remaining 20 patients (23%), emergency VCE was performed, which was feasible in 19 of 20 patients (95%; 95% confidence interval [CI], 75%-99%). Emergency VCE correctly guided further diagnostic and therapeutic procedures in 17 of 20 patients (85%; 95% CI, 62%-97%) and showed a diagnostic yield of 75% (95% CI, 51%-91%). LIMITATIONS Single-center study, small sample size. CONCLUSION In patients with acute severe GI bleeding and negative upper endoscopy results, emergency VCE can be useful for the immediate detection of the bleeding site and is able to guide further therapy. (Clinical trial registration number: NCT01584869.)
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Zhou B, Huang S, Chen Y, Guo YY, Liu XX, Fan J. Diagnostic value of upper digestive tract radiography in children with congenital hypertrophic pyloric stenosis. Shijie Huaren Xiaohua Zazhi 2015; 23:121-124. [DOI: 10.11569/wcjd.v23.i1.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the diagnostic value of upper digestive tract radiography in children with congenital hypertrophic pyloric stenosis.
METHODS: Clinical data for 88 children with congenital hypertrophic pyloric stenosis treated at Wuhan Medical Care Center for Women and Children Hospital from January 2012 to January 2014 were retrospectively analyzed. Upper digestive tract radiography was performed preoperatively in all the patients.
RESULTS: Of the 88 children, 40 (45.45%) had shoulder-like symptoms, 16 (18.18%) had nipple sign, 40 (45.45%) had line-like sign, 20 (22.72%) had pileus sign, 29 (32.95%) had beak sign, and 30 (34.09%) had tram line sign. Upper digestive tract radiography showed that pyloric duct diameter was 15.1 mm ± 0.80 mm, pyloric duct length 22.1 mm ± 2.04 mm, and pyloric muscle thickness 5.2 mm ± 0.61 mm. Intraoperatively measured pyloric tube measured pyloric duct diameter was 15.5 mm ± 0.71 mm, pyloric duct length 23.1 mm ± 2.15 mm, and pyloric muscle thickness 4.7 mm ± 0.69 mm, which were significantly different from those measured by radiography (P < 0.05).
CONCLUSION: Upper gastrointestinal tract radiography has very important diagnostic significance in children with congenital hypertrophic pyloric stenosis.
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Kim BSM, Li BT, Engel A, Samra JS, Clarke S, Norton ID, Li AE. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World J Gastrointest Pathophysiol 2014; 5:467-478. [PMID: 25400991 PMCID: PMC4231512 DOI: 10.4291/wjgp.v5.i4.467] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/15/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.
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Parekh PJ, Buerlein RC, Shams R, Vingan H, Johnson DA. Evaluation of gastrointestinal bleeding: Update of current radiologic strategies. World J Gastrointest Pharmacol Ther 2014; 5:200-208. [PMID: 25374760 PMCID: PMC4218949 DOI: 10.4292/wjgpt.v5.i4.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/10/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal bleeding (GIB) is a common presentation with significant associated morbidity and mortality, the prevalence of which continues to rise with the ever-increasing aging population. Initial evaluation includes an esophagoduodeonscopy and/or colonoscopy, which may fail to reveal a source. Such cases prove to be a dilemma and require collaboration between gastroenterology and radiology in deciding the most appropriate approach. Recently, there have been a number of radiologic advances in the approach to GIB. The purpose of this review is to provide an evidence-based update on the most current radiologic modalities available and an algorithmic approach to GIB.
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Hemorragia en anastomosis intestinales y cólicas. Manejo terapéutico y sus complicaciones. Cir Esp 2014; 92:463-7. [DOI: 10.1016/j.ciresp.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 01/30/2023]
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Dudeck O. Safety and efficacy of target vessel catheterization with the new steerable microcatheter Direxion compared with a standard microcatheter: a prospective, preclinical trial. Cardiovasc Intervent Radiol 2014; 37:1041-6. [PMID: 24849303 DOI: 10.1007/s00270-014-0918-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the potential of a steerable microcatheter in a comparative preclinical trial. METHODS A total of 100 small target vessels of the lower limbs with a maximum diameter of 3 mm were prospectively randomized to catheterize with either the preshaped torqueable Direxion™ (J tip shape; Boston Scientific, Natick, MA) or a similarly steam-shaped Renegade™ microcatheter (Boston Scientific) in a porcine model. Catheterization was first performed in combination with a microguidewire and afterwards without. RESULTS No significant differences were found for the mean vessel diameter in the Direxion (1.53 ± 0.44 mm; n = 50) or Renegade (1.62 ± 0.43 mm; n = 50; p = 0.35) group. Guidewire-assisted catheterization was successful in all target vessels, whereas access was achieved in most cases with the guidewire alone. However, when it became necessary to steer the Direxion actively, this was regarded as key to obtain vessel access in three of four target vessels (75 %). Vessel catheterization without guidewire was significantly more successful with the Direxion (88 %; n = 44) compared with the Renegade (32 %; n = 16; p < 0.0001). In addition, this catheterization technique was also significantly faster with the Direxion compared with guidewire-assisted vessel catheterization with the Renegade (16.1 ± 14.4 sec compared with 27.1 ± 24.7 sec; p = 0.011). CONCLUSIONS The Direxion microcatheter demonstrated unique steerability characteristics, which makes it a promising new tool especially for complex coaxial endovascular procedures.
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Affiliation(s)
- Oliver Dudeck
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany,
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