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Clinical assessment and treatment algorithm for lower gastrointestinal bleeding

Soo-Kyung Park

Abstract : Lower gastrointestinal bleeding (LGIB) is diagnosed in 20% to 30% of all patients presenting with major gastrointestinal (GI) bleeding. Although most patients with acute LGIB stop bleeding spontaneously and have favorable outcomes, morbidity and mortality ranges from 2% to 4%, and is higher in older patients and those with comorbid medical conditions. Common etiologies of LGIB are diverticular bleeding, ischemic colitis, angioectasia bleeding and hemorrhoid. Patients presenting with acute severe hematochezia should undergo a focused evaluation simultaneous with hemodynamic resuscitation. An upper GI bleeding source must be excluded in patients with hematochezia and hemodynamic instability. Colonoscopy following a colon preparation is the initial test of choice in most patients presenting with acute hematochezia and hemodynamic stability.

Role of computed tomography angiography for acute gastrointestinal bleeding

Chul-min Lee, Jong Keon Jang, Ji Hoon Shin, Soon-Young Song, and Bo-kyeong Kang

Abstract : Acute gastrointestinal (GI) bleeding is a common cause of emergency department admission and hospitalization. Diagnosis and treatment requires promptly with a multidisciplinary approach to reduce morbidity and mortality of acute GI bleeding. Many diagnostic modalities are being used in the evaluation of GI bleeding, each with its own strengths and weaknesses. With the recent advances in technology, computed tomography (CT) angiography has become an effective first-line method for imaging the cause of GI bleeding to guide management. The purpose of this review is to discuss diagnostic modalities of GI bleeding, with a focus on the emerging role of CT angiography.

Endoscopic treatment of surgery or procedure-related gastrointestinal bleeding

Ki Bae Bang, and Hyun Deok Shin

Abstract : Endoscopy is a safe and effective modality for the diagnosis and treatment of lesions in the gastrointestinal (GI) tract. During the last few decades, improvements in image quality and technical advances have led to the widespread use of endoscopy in various medical fields. Because it is relatively noninvasive and generally safe, the role of endoscopy has been emphasized in morbid patients with postoperative GI bleeding. However, there has been concern about the safety and complications of endoscopy. Here, we review endoscopic management of GI bleeding as a complication of surgery and therapeutic endoscopy.

Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding

Tae-Geun Gweon, and Jinsu Kim

Abstract : Gastrointestinal bleeding (GIB) is a major cause of hospital admission and death. Endoscopic treatment is an important therapeutic modality for the treatment of GIB, and can involve injection therapy, thermal therapy, hemoclipping, and ligation therapy. In addition to hemostatic devices, new endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have been developed. The causes, therapeutic modalities, and outcomes of GIB differ according to bleeding source. This review comprehensively describes the outcomes of endoscopic treatment of GIB.

New endoscopic techniques in treating gastrointestinal bleeding

Young Sin Cho

Abstract : Gastrointestinal (GI) bleeding is a common disorder encountered in an emergency department or primary clinical setting. The therapeutic basis for GI bleeding is endoscopic hemostasis. To date, epinephrine injection, through-the-scope clips, monopolar or biopolar coagulation, and band ligation have been established for GI bleeding. Despite the advances in endoscopic techniques, we often experience re-bleeding associated with significant inhospital mortality in GI bleeding. New devices that complement the disadvantages of these conventional endoscopic techniques have recently been introduced. For example, over-the-scope clip, which has wider and stronger pressure than conventional mechanical devices, can ligate a wide range of surrounding mucous membranes and has been reported to be effective in severe lesions of fibrosis. In addition, hemostatic powders achieved successful hemostasis as primary or rescue therapy in several cases of GI bleeding. Successful application of these new techniques requires appropriate patient selection and understanding of the device and further research is expected in the future.

Role of surgery in gastrointestinal bleeding

Jae-Sun Kim, and In-Seob Lee

Abstract : With the help of the evolution of endoscopic and angiographic intervention, nonsurgical techniques became the procedures of choice for the diagnosis and treatment of gastrointestinal (GI) bleeding and role of surgery have been decreased. However, surgical operations are still necessary for controlling bleeding lesions when these maneuvers fail and conventional operations continue to be life-saving in many instances. Laparoscopic surgeries have an advantage of less postoperative pain and wound problem, quicker recovery, and shorter hospital stay and been widely used for GI bleeding. An elective laparoscopic resection of the intestine for appropriate indications may be an ideal application of this technique, while emergent use should be tempered by skillful surgeons because most patients are relatively unstable and time-limited. Newly developed technologies will continue to facilitate collaboration and cooperation between gastroenterologists, radiologists, and surgeons by encouraging working in multispecialty teams. This review will address the surgical approach associated with various treatments for GI bleeding according to many kinds of GI bleeding diseases.

Essential vascular anatomy and choice of embolic materials in gastrointestinal bleeding

Somrach Thamtorawat , Chandran Nadarajan, and Satit Rojwatcharapibarn

Abstract : Non-variceal gastrointestinal bleeding is the significant emergency problem to manage in the hospital. Transcatheter arterial embolization is minimally invasive treatment, which becomes an essential role in controlling bleeding, leading to lifesaving. To reach the goal, the interventional radiologist should have fundamental of vascular anatomy and choice of embolic material, which is the key to success.

Provocative mesenteric angiography for diagnosis and treatment of occult gastrointestinal hemorrhage

Charles Y. Kim

Abstract : Occult gastrointestinal (GI) hemorrhage can be a great challenge to both patients and physicians, exerting a great toll on patients and the healthcare system. While diagnostic capabilities for diagnosing GI bleeding are improving, particularly with the establishment of computed tomography angiography and capsule endoscopy as routine modalities, patients with intermittent massive GI bleeding continue to pose a diagnostic and management dilemma. In this review, the concept, efficacy, and safety of provocative mesenteric angiography is described. The body of literature suggests that this procedure is safe and effective in this patient population with little to no alternative options.

Outcomes and complications of embolization for gastrointestinal bleeding

In Joon Lee

Abstract : Gastrointestinal bleeding is a common medical emergency with significant morbidity and mortality. Although endoscopic treatment was recommended as the first-line approach, it is often limited in real clinical practice. Over the past few decades, transcatheter arterial embolization has become a major treatment modality for the management of gastrointestinal bleeding that is refractory to endoscopic management. This review aims to describe the outcomes and complications of transcatheter arterial embolization for gastrointestinal bleeding.