Selective arterial embolization for control of lower gastrointestinal bleeding: recommendations for a clinical management pathway

Abstract

Purpose Angiography remains as the modality of choice in the diagnosis of lower gastrointestinal bleeding. Traditionally, angiography is used for localization of a bleeding source for surgical resection. Advances in transcatheter techniques have allowed for hemorrhage control through embolization of bleeding points, without the need for emergent laparotomy. Methods A series of 10 consecutive patients who underwent angiographic embolization for lower gastrointestinal hemorrhage was retrospectively reviewed. Success and complication rates, as well as post-embolization follow-up methods, were recorded. Results Over a 3-year period, 10 angiographic embolizations were performed for lower gastrointestinal hemorrhage. Average age of the patients was 75 years. Source of hemorrhage included diverticular disease in 4 patients, cancer in 2, polyps in 2, angiodysplasia in 1, and anastomotic bleeding in 1. Six patients required no further therapy. Four patients went on to have surgery: Three secondary to recurrent hemorrhage, 1 due to sepsis from ischemic bowel necrosis. There were no deaths. Four patients had an abdominal and pelvic computed tomography (CT) scan within 48 hours of embolization. Four patients had a colonoscopy within 48 hours of the procedure. Conclusions Angiography remains an important diagnostic tool in the management of lower gastrointestinal bleeding. In addition, it is a safe and effective treatment option, especially in patients with high surgical risk. Hemorrhage control obtained in the angiography suite may allow for patient stabilization and resuscitation with staging and bowel preparation for surgery. Patients need to be carefully monitored for evidence of bowel ischemia through the use of colonoscopy or computed tomography.