Gastrointestinal Tract Bleeding

Angiography
for Lower Gastrointestinal Tract Bleeding

   

• Cohn
  SM, Moller BA, Zeig PM, et al
  
  Angiography
  for Preoperative Evaluation in Patients with Lower
  Gastrointestinal are the Benefits Worth the Risks?
  
  Arch Surg 133: 50-55, 1998
  
    
  
  Whether angiography is beneficial in acute lower
  gastrointestinal [GI] tract bleeding to identify the
  site of bleeding and limit the extent of colonic
  resection is controversial. The impact of selective angiography on the clinical decision making
  in the management of lower GI tract bleeding and the
  associated morbidity of the procedure were
  determined retrospectively.
  
    
  
  Records
  of 65 patients [37 women and 28 men] aged 27 to 93
  years, undergoing 75 angiography procedures for
  evaluation of acute lower GI tract bleeding were
  reviewed. Associated
  medical problems, factors contributing to an
  increased risk of bleeding, and diagnostic methods
  were noted.
  
     
  
  Nine
  patients had more than one angiography done. 
  Angiographic studies were abnormal in 23
  patients [35%] and 14 of these required surgery;
  normal in 42 patients and 8 required surgery. Of the
  22 cases operated 11 had a hemicolectomy [9 on the
  basis of angiography], 10 had a subtotal colectomy
  and one had a small bowel tumor resection.
  Three hemicolectomy patients [two with normal
  angiographic findings] later required a subtotal
  colectomy. Six
  patients [3 had surgery] died. 
  Seven patients [11%] had angiography 
  related complications.
  
     
  
  Angiography
  identified the specific site of bleeding only in 8
  patients [12%]. Complication rate from angiography
  was 11%. Most patients [66%] did not require surgery
  including 9 out of 23 [39%] with abnormal
  angiographic findings.
  
     
  
  Angiography
  does not give sufficient information on how to
  manage a patient with lower GI tract bleeding and
  carries a relatively high risk [11%] of
  complications.