Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization

Quality Improvement Guidelines for Transcatheter Embolization for Acute Gastrointestinal Nonvariceal Hemorrhage

“…A combination of embolic materials can be beneficial (microcoils with gelatin foam or microparticles) to reduce the risk of rebleeding [24]. Selective intra-arterial infusion of vasoconstrictor agents is rarely used due to the high frequency of rebleeding ([50 %) [8,25,26] and occurrence of systemic side effects [6]. It could be considered for diffuse mucosal hemorrhage, diverticular bleeding, postpolypectomy, or lesions inaccessible to a microcatheter.…”

Long-term results of microcoil embolization for colonic haemorrhage: how common is rebleeding?

“…vasopressin) have concluded the superiority of coil embolization in the vast majority of indications, reserving vasoconstrictive therapy mainly for patients with multifocal bleeding or technically challenging cases that preclude superselective catheterization. 18,19 When compared with colonoscopy and surgery, however, the optimal sequence for management of colonic haemorrhage remains controversial. Initial guidelines by the American College of Gastroenterology, published in 1998, advocated the usage of colonoscopy for initial work-up, reserving arteriography and surgery as salvage therapy in unsuccessful or refractory cases.…”

“…Additionally, prior published data on endovascular technique is limited by a majority of studies using a combination of different embolic agents to manage lower GI bleeding, consequently confounding the evaluation for efficacy of any one single agent. 4,[11][12][13][14][15][17][18][19]25,27,28 The present study sought to address this concern by examining both early and delayed rebleeding rates in patients managed specifically by superselective microcoil embolization, yielding rates of 11.5% and 15.3%, respectively. These findings take an initial step at showing the ability to achieve long-term haemostasis in most patients treated by endovascular coiling alone.…”

“…Additionally, as most other published literature on transcatheter embolization is confounded by the usage of a variety of embolic agents, the results from this study show the overall low risk of ischaemia when microcoils are used in a superselective manner. 4,[11][12][13][14][15][17][18][19]25,27,28 The belief is that superselective coiling limits the area of embolization to the diseased or actively bleeding segment of large bowel in such a fashion that arrests bleeding but avoids end organ necrosis and ischaemia. 3 This is in contrast to other embolic agents such as particles, gelatin sponge or liquid embolic (i.e.…”

Lower gastrointestinal hemorrhage: emergency room management

“…El tratamiento quirúrgico de emergencia es necesario en 10% -25% de los casos, para extirpar la zona del sangrado activo. Está indicado en pacientes con sangrado masivo o persistente en quienes han fallado el tratamiento conservador, los procedimientos colonoscópicos y angiográficos (26)(27)(28).Para indicar la cirugía debemos tener en cuenta: 1.-si hay necesidad de transfusión de 3 o más unidades de glóbulos rojos durante la resucitación inicial y evidencia de sangrado persistente, 2.-Transfusión de 4 o más unidades de glóbulos rojos en 24 horas para mantener estabilidad hemodinámica,3.-Sangrado persistente por más de 72 horas, 4.-Recaída del sangrado antes de 7 días, con inestabilidad hemodinámica, 5.-Tipo y grupo sanguíneo de difícil obtención (7)(8)(9)29,30).…”