Treatment of gastrointestinal hemorrhage

Charbonnet, Pierre; Toman, James E. P.; Bühler, L.; Vermeulen, B.; Morel, Philippe; Becker, Christoph; Terrier, François

doi:10.1007/s00261-005-0314-8

Cited by 26 publications

(15 citation statements)

References 28 publications

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“…Super selective AE is a safe, feasible and effective method for treating active lower GI bleeds with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischaemia and late rebleeding [10][11][12]. In our experience, it is often difficult to demonstrate a bleeding point in the small or large bowel in a patient with a previous history of a GI bleed.…”

Section: Discussionmentioning

confidence: 97%

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

et al. 2009

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Section: Discussionmentioning

confidence: 97%

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

et al. 2009

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“…Limitations of angiography include the need for higher rates of bleeding (0.5-1.0 ml/min) for detection and the risk of complications (including renal failure, thromboembolic events, and more commonly infections or bleeding at the catheter site) that can occur in up to 10% ( 183,188 ). Data from multiple studies assessing results throughout the GI tract show yields for angiography in the range of 20-77% with a mean near 50% ( 181,182,(189)(190)(191).…”

Section: Angiographymentioning

confidence: 93%

“…Because bleeding is intermittent, scintigraphy may be helpful in identifying the site of bleeding when other diagnostic tests have been negative (180)(181)(182).…”

Section: Scintigraphy 99mmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

545

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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“…Reported yields range from 20% to 77% in GI bleeding. 26,116,117 Angiography carries the potential for therapy. Selective mesenteric embolization can be considered to reduce the risk of intestinal ischemia, which is a concern with embolization.…”

Section: Role Of Intraoperative Enteroscopymentioning

confidence: 99%