Interventional radiological treatment of gastrointestinal bleeding

Summary   Background: Gastrointestinal (GI) bleeding is divided into upper and lower GI bleeding. The most common reasons for upper GI bleeding are gastric and duodenal ulcers. Lower GI bleeding is located in the intestine below the ligament of Treitz. In this review article the possibilities for interventional radiological treatment of gastrointestinal bleeding will be discussed. Methods: Interventional treatment in form of embolization of arterial branches of the celiac trunc is indicated if endoscopic approaches fail to stop the bleeding. Localization and treatment of lower GI bleeding is more difficult and technically more demanding. Embolization of mesenteric branches may be effective to stop bleeding but carries the risk of inducing bowl ischemia. Sometimes surgical exploration can be necessary after embolization. However, especially in severe bleeding, embolization may help to stabilize the patient before major surgery. If the bleeding source can not be identified, intraarterial infusion of vasoactive drugs, like vasopressin, may be effective. Results: In upper GI bleeding, hemostasis can be achieved by transarterial embolization in up to 91 %. In lower GI bleeding the success rate is less well defined, since there are no larger series available in the current literature. In all embolization procedures, the risk of ischemic bowl damage has to be considered. This complication occurs more often in embolization after in lower GI bleeding. Conclusions: Transarterial embolization offers an efficient treatment of upper and lower GI bleeding. It should be used for upper GI bleeding when endoscopic hemostasis is not so successful. In lower GI bleeding transarterial embolization often has the character of a temporizing procedure before surgery.