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Digestive Disease Interventions 2024; 08(01): 92-97
DOI: 10.1055/s-0043-1771314
Review Article

Nonvariceal Upper Gastrointestinal Hemorrhage: The Interventional Radiologist's Perspective

Oscar Mauricio Rivero Rapalino 
1   Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Bogotá, Colombia
,
Lorena Garza García
2   Radiology Associates of Albuquerque, Albuquerque, New Mexico
,
David Fernando Torres Cortes 
1   Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Bogotá, Colombia
› Author Affiliations Funding None.
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Abstract

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common diseases of the GI tract and represents a high percentage of emergency room admissions. Eighty percent to 90% of upper GI bleeds are nonvariceal, with a mortality of 1 to 10% of patients. Selective embolization of the arterial source can be achieved with many therapeutic alternatives available in the interventional radiologist's arsenal, such as particles, coils, liquid emboli, selectively infused vasoconstrictor agents, or a combination of these techniques. Up to 95% of patients can obtain initial hemostasis without angiographic intervention. However, rebleeding is common, occurring in up to 50% of patients and persistent hemorrhage has been described in 7 to 30% of patients with mortality rates up to 14%.

Keywords

gastrointestinal tract - hemorrhage - embolization - coils


Publication History

Received: 05 December 2022

Accepted: 20 June 2023

Article published online:
07 August 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Loffroy R, Estivalet L, Cherblanc V. et al. Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding. World J Gastrointest Surg 2012; 4 (10) 223-227
    CrossrefPubMedSearch in Google Scholar
  • 2 Wee E. Management of nonvariceal upper gastrointestinal bleeding. J Postgrad Med 2011; 57 (02) 161-167
    CrossrefPubMedSearch in Google Scholar
  • 3 Aljarad Z, Mobayed BB. The mortality rate among patients with acute upper GI bleeding (with/without EGD) at Aleppo University Hospital: a retrospective study. Ann Med Surg (Lond) 2021; 71: 102958
    CrossrefPubMedSearch in Google Scholar
  • 4 Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol 2017; 17 (01) 165
    CrossrefPubMedSearch in Google Scholar
  • 5 Miller Jr M, Smith TP. Angiographic diagnosis and endovascular management of nonvariceal gastrointestinal hemorrhage. Gastroenterol Clin North Am 2005; 34 (04) 735-752
    CrossrefPubMedSearch in Google Scholar
  • 6 Farghadani M, Momeni M, Hekmatnia A, Momeni F, Baradaran Mahdavi MM. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: evaluation with multidetector computed tomography angiography. J Res Med Sci 2016; 21: 129
    CrossrefPubMedSearch in Google Scholar
  • 7 Zhan XB, Guo XR, Yang J, Li J, Li ZS. Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis. J Dig Dis 2015; 16 (01) 37-42
    CrossrefPubMedSearch in Google Scholar
  • 8 Singh-Bhinder N, Kim DH, Holly BP. et al; Expert Panels on Vascular Imaging and Gastrointestinal Imaging. ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding. J Am Coll Radiol 2017; 14 ( 5S ) S177-S188
    CrossrefPubMedSearch in Google Scholar
  • 9 Millward SF. ACR Appropriateness Criteria on treatment of acute nonvariceal gastrointestinal tract bleeding. J Am Coll Radiol 2008; 5 (04) 550-554
    CrossrefPubMedSearch in Google Scholar
  • 10 Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol 2010; 33 (06) 1088-1100
    CrossrefPubMedSearch in Google Scholar
  • 11 Ramaswamy RS, Choi HW, Mouser HC. et al. Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol 2014; 6 (04) 82-92
    CrossrefPubMedSearch in Google Scholar
  • 12 Shin JH. Refractory gastrointestinal bleeding: role of angiographic intervention. Clin Endosc 2013; 46 (05) 486-491
    CrossrefPubMedSearch in Google Scholar
  • 13 Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol 2012; 13 (Suppl 1, Suppl 1) S31-S39
    CrossrefPubMedSearch in Google Scholar
  • 14 Yu Q, Funaki B, Navuluri R. et al. Empiric transcatheter embolization for acute arterial upper gastrointestinal bleeding: a meta-analysis. AJR Am J Roentgenol 2021; 216 (04) 880-893
    PubMedSearch in Google Scholar
  • 15 Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol 2012; 13 (01) 31-39
    CrossrefPubMedSearch in Google Scholar
  • 16 Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol 2003; 14 (05) 535-543
    CrossrefPubMedSearch in Google Scholar
  • 17 Padia SA, Geisinger MA, Newman JS, Pierce G, Obuchowski NA, Sands MJ. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol 2009; 20 (04) 461-466
    CrossrefPubMedSearch in Google Scholar
  • 18 Loffroy R, Guiu B, D'Athis P. et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol 2009; 7 (05) 515-523
    CrossrefPubMedSearch in Google Scholar
  • 19 Aina R, Oliva VL, Therasse E. et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001; 12 (02) 195-200
    CrossrefPubMedSearch in Google Scholar
  • 20 Mine T, Murata S, Nakazawa K. et al. Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process. Acta Radiol 2013; 54 (08) 934-938
    CrossrefPubMedSearch in Google Scholar
  • 21 Rösch J, Keller FS, Kozak B, Niles N, Dotter CT. Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding. Radiology 1984; 151 (02) 365-370
    CrossrefPubMedSearch in Google Scholar
  • 22 Koo HJ, Shin JH, Kim HJ. et al. Clinical outcome of transcatheter arterial embolization with N-butyl-2-cyanoacrylate for control of acute gastrointestinal tract bleeding. AJR Am J Roentgenol 2015; 204 (03) 662-668
    CrossrefPubMedSearch in Google Scholar
  • 23 Kim PH, Tsauo J, Shin JH, Yun SC. Transcatheter arterial embolization of gastrointestinal bleeding with N-butyl cyanoacrylate: a systematic review and meta-analysis of safety and efficacy. J Vasc Interv Radiol 2017; 28 (04) 522-531.e5
    CrossrefPubMedSearch in Google Scholar
  • 24 Hussey KP. Vasopressin therapy for upper gastrointestinal tract hemorrhage. Has its efficacy been proven?. Arch Intern Med 1985; 145 (07) 1263-1267
    CrossrefPubMedSearch in Google Scholar
  • 25 Walker TG. Acute gastrointestinal hemorrhage. Tech Vasc Interv Radiol 2009; 12 (02) 80-91
    CrossrefPubMedSearch in Google Scholar
  • 26 Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011; 66 (06) 500-509
    CrossrefPubMedSearch in Google Scholar
  • 27 Elmi A, Walker TG, Ganguli S, Kalva SP. The clinical and technical effectiveness of endovascular embolization in patients with nonvariceal gastrointestinal bleeding. J Clin Interv Radiol ISVIR 2017; 01 (01) 5-12
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Lundgren JA, Matsushima K, Lynch FC, Frankel H, Cooney RN. Angiographic embolization of nonvariceal upper gastrointestinal bleeding: predictors of clinical failure. J Trauma 2011; 70 (05) 1208-1212
    PubMedSearch in Google Scholar