Published online Jul 16, 2021. doi: 10.4253/wjge.v13.i7.221
Peer-review started: April 5, 2021
First decision: June 7, 2021
Revised: June 17, 2021
Accepted: July 7, 2021
Article in press: July 7, 2021
Published online: July 16, 2021
The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment. However, a small number of these may pose a challenge in terms of therapy because the patients develop hemodynamic instability, and endoscopy does not achieve adequate hemostasis. Interventional radiology supplemented with catheter angiography (CA) and transarterial embolization have gained importance in recent times.
To evaluate clinical predictors for angiography in patients with lower gastro
We compared two groups of patients in a retrospective analysis. One group had been treated for more than 10 years with CA for LGIB (n = 41). The control group had undergone non-endoscopic or endoscopic treatment for two years and been registered in a bleeding registry (n = 92). The differences between the two groups were analyzed using decision trees with the goal of defining clear rules for optimal treatment.
Patients in the CA group had a higher shock index, a higher Glasgow-Blatchford bleeding score (GBS), lower serum hemoglobin levels, and more rarely achieved hemostasis in primary endoscopy. These patients needed more transfusions, had longer hospital stays, and had to undergo subsequent surgery more frequently (P < 0.001).
Endoscopic hemostasis proved to be the crucial difference between the two patient groups. Primary endoscopic hemostasis, along with GBS and the number of transfusions, would permit a stratification of risks. After prospective confirmation of the present findings, the use of decision trees would permit the identification of patients at risk for subsequent diagnosis and treatment based on interventional radiology.
Core Tip: Transarterial embolization enables the clinician to control gastrointestinal bleeding with high rates of technical and clinical success. We still do not know when the clinician should conclude endoscopic procedures to control gastrointestinal bleeding. This retrospective study compared patients with conservative treatment and patients who underwent catheter angiography. Patients in the catheter angiography group had a higher shock index, a higher Glasgow-Blatchford score and more rarely achieved hemostasis in primary endoscopy. These patients needed more transfusions, had longer hospital stays and had to undergo subsequent surgery more frequently. Endoscopic hemostasis proved to be the crucial difference between the two patient groups.