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World J Gastroenterol. Mar 21, 2012; 18(11): 1191-1201
Published online Mar 21, 2012. doi: 10.3748/wjg.v18.i11.1191
Angiographic evaluation and management of acute gastrointestinal hemorrhage
T Gregory Walker, Gloria M Salazar, Arthur C Waltman
T Gregory Walker, Gloria M Salazar, Arthur C Waltman, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: All authors contributed to this paper.
Correspondence to: T Gregory Walker, MD, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street GRB 290A, Boston, MA 02114, United States.
Telephone: +1-617-7268315 Fax: +1-617-7268476
Received: June 1, 2011
Revised: July 6, 2011
Accepted: July 13, 2011
Published online: March 21, 2012

Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment, there are still a significant number of patients who require emergency angiography and transcatheter treatment. Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography. Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic and imaging data. If a hemorrhage source is identified, superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications. This is now well-recognized as a viable and safe alternative to emergency surgery. In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding. One must be aware of the various side effects and potential complications associated with this treatment, however, and recognize the high re-bleeding rate. In this article we review the current role of angiography, transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.

Keywords: Angiodysplasia, Aneurysm, Digital subtraction angiography, Contrast media, Hemorrhage, Radionuclide angiography, Therapeutic embolization