Die akute gastrointestinale Blutung aus der Sicht des interventionellen Radiologen – Möglichkeiten und Grenzen

Abstract

Currently, interventional radiological techniques are an accepted part of the multidisciplinary treatment of the patient with acute massive gastrointestinal hemorrhage. The main limitation to its wider use in arterial hemorrhage is the visualisation of the bleeding lesion by catheter angiography. In arterial gastro-duodenal hemorrhage transcatheter embolisation plays a minor role as compared to endoscopic techniques, but remains an option for endoscopic treatment failures and inoperable patients. Acute transpapillary bleeding are best addressed by radiological means. Microcatheter embolisation of small bowel and colonic bleeding has proven to be safe and efficacious in the emergency setting. The transjugular intrahepatic porto-systemic shunt (TIPS) with or without transvenous variceal embolisation enables the control of almost any acute variceal bleed. The prevention of rebleeding has further improved since the introduction stentgrafts. Its wider use is limited by the TIPS-related encephalopathy.