Endovascular Therapy of Gastrointestinal Bleeding

Abstract

Background Gastrointestinal (GI) bleeding is a frequently occurring disease pattern, with a broad variety of possible causes. The most acute bleeding responds well to conservative, medicinal and endoscopic therapies. Nevertheless, a certain amount of endoscopically not-identifiable or controllable non-varicose GI-bleeding requires alternative, sometimes surgical, therapy concepts. The updated S2k guideline “gastrointestinal bleeding” makes the case for interventional radiology with its minimally invasive endovascular techniques. Methods This review article discusses the role of interventional radiology in the therapy of non-variceal upper and lower gastrointestinal bleeding according to the current literature and updated guideline. In this regard it covers the indications, techniques, results and complications of endovascular therapy. Results and conclusion Considering interdisciplinary therapy options, the guideline-oriented endovascular treatment of gastrointestinal bleeding, using embolization and implantion of covered stents, shows to be a reasonable option with good technical and clinical success rates and a low rate of complications. In this context solid knowledge of vascular anatomy is essential to acquire adequate hemostasis. Key points: Citation Format

Availability of Transcatheter Vessel Occlusion Performed by Interventional Radiologists to Treat Bleeding in Germany in the Years 2016 and 2017 – An Analysis of the DeGIR Registry Data

“…In contrast to open surgery and often also endoscopic procedures, endovascular treatment is usually highly targeted and is gentle to surrounding tissue structures. In addition, intubation anesthesia is sometimes not necessary [9].…”

“…Finally, not only the effectiveness and quality of a certain technique but also its availability and the structural distribution of centers with sufficient practical experience for regional coverage of need are decisive for practical patient care. This was recently evidenced by the rapid development of the interventional radiological treatment of strokes by means of thrombectomy [9].…”

Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature

“…The choice of embolic material is an essential part of the interventional embolization process and is primarily influenced by the operator experience, the cause of bleeding, and the coagulation status [ 49 ].…”

“…In our experience, coils were employed alone in 52/91 (57.1%) patients and combined with other embolic agents in 30/91 (33.0%) patients. In previous reports, coils had a higher technical success rate both for UGIB and LGIB [ 49 ], and a reduced risk of rebleeding [ 13 ].…”

Endovascular Treatment of Gastrointestinal Hemorrhage

“…Non-variceal gastrointestinal tract (GIT) bleeding is often a sudden, life-threatening condition. In 85% of patients, we encounter bleeding from the upper GIT [ 1 ], which includes the part of the GIT from the esophagus to the ligament of Treitz, and lower GIT bleeding, which includes bleeding from the small intestine, colon, and rectum. Most bleeding episodes resolve spontaneously or after conservative treatment.…”