Angiography in the diagnosis of ulcerative gastroduodenal bleeding
DOI:
https://doi.org/10.15574/PS.2024.4(85).4351Keywords:
acute gastrointestinal bleeding, ulcer disease of the stomach, ulcer disease of the duodenum, angiography of the stomach and duodenal arteriesAbstract
Acute Gastrointestinal Bleeding (AGIB) of Ulcerative Origin poses a life-threatening risk and requires a clear diagnostic and therapeutic strategy. If endoscopic hemostasis and conservative therapy are ineffective, an essential method is angiography of the stomach and duodenal vessels to identify the bleeding source and perform endovascular hemostasis.
Aim: to study the angiographic semiotics of AGIB of ulcerative origin to improve the efficiency of diagnosis and treatment; to assess the capabilities of superselective arteriography in determining the bleeding source and its impact on the choice of endovascular hemostasis tactics.
Materials and methods. The results of angiographic examination of the stomach and duodenal vessels in 17 patients with gastroduodenal ulcers complicated by AGIB were analyzed. All patients had a high surgical risk amid active bleeding. The examined parameters included direct angiographic signs and indirect signs.
Results. In 14 (82.4%) patients, who underwent angiography during active bleeding, the bleeding source was directly identified based on contrast extravasation, pseudoaneurysm, or intense contrast accumulation at the ulcer site. In 3 (17.4%) patients, only indirect signs (arterial spasm, hypervascularization, arteriovenous shunting) were noted.
Conclusions. The study of angiographic patterns of AGIB sources in patients with ulcer disease showed that superselective arteriograms were the most informative. Performing superselective arteriography with the identification of direct and indirect angiographic signs of bleeding allowed precise localization of the source in the celiac trunk or superior mesenteric artery, followed by appropriate endovascular hemostasis based on the angiographic findings.
The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the local ethics committee of the institutions mentioned in the study. Informed consent was obtained from all participants.
The authors declare no conflict of interest.
References
Asadov SA. (2002). Surgical treatment of "difficult" and complicated gastroduodenal ulcers. Khirurgiia. (11): 64-69. PMid: 12501470.
Avdosev YuV, Boiko VV, Belozerov YV, Kudrevych AN, Andreev HY. (2015). Angiography and X-ray endovascular surgery of thoracoabdominal bleeding. Uchebnyk. Kharkov: KhNU ymeny V. N. Karazyna: 842.
Avdosev YuV, Boiko VV, Polevoi VP, Dziubanovskyi YIa, Dziubanovskyi OY, Popadiuk OIa. (2020). Angiographic semiotics and X-ray endovascular surgery in the treatment of abdominal and gastrointestinal bleeding. Monohrafyia. Lvov: Mahnolyia 2006: 664.
Avdosev YuV, Boiko VV. (2011). Angiography and X-ray endovascular surgery of abdominal bleeding. Monohrafyia. Kharkov: Yzdatel Savchuk OO: 648.
Avdosiev YuV, Boiko VV. (2022). Angiography and X-ray endovascular surgery of internal and external bleeding. Monohrafiia. Instytut zahalnoi ta nevidkladnoi khirurhii imeni V.T. Zaitseva NAMNU. Kharkiv : Vydavets Oleksandr Savchuk: 512.
Bazan HA, Kim U. (2003). Fatal gastroduodenal artery bleeding. Gastrointest Endosc. 58(5): 755. https://doi.org/10.1016/S0016-5107(03)02109-6; PMid:14595314
Bini EJ, Cohen J. (2003) Endoscopic treatment compared with medical therapy for the prevention of recurrent ulcer hemorrhage in patients with adherent clots. Gastrointest Endosc. 58(5): 707-714. https://doi.org/10.1016/S0016-5107(03)02014-5; PMid:14595306
Botianu A, Matei D, Tantau M, Acalovschi M. (2013). Mortality and need of surgical treatment in acute upper gastrointestinal bleeding: a one year study in a tertiary center with a 24 hours / day-7 days / week endoscopy call. Has anything changed? Chirurgia (Bucur). 108(3): 312-318. PMid: 23790778.
Cho Y, Park SJ, Lee S, Lee HN, Bae SH, Cho S. (2020). Gastrointestinal bleeding after failed endoscopic hemostasis: diagnostic efficacy of angiography compared with computed tomography and treatment outcomes of transcatheter arterial embolization. Jpn J Radiol. 40(6): 630-638. Epub 2022 Jan 17. https://doi.org/10.1007/s11604-022-01246-5; PMid:35038114
Chung IK, Kim EJ, Lee MS, Kim HS, Park SH, Lee MH et al. (2001). Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers. Endoscopy. 33(11): 969-975. https://doi.org/10.1055/s-2001-17951; PMid:11668406
Defreyne L, Vanlangenhove P, De Vos M, Pattyn P, Van Maele G, Decruyenaere J et al. (2001). Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology. 218(3): 739-748. https://doi.org/10.1148/radiology.218.3.r01mr05739; PMid:11230648
Dousset B, Suc B, Boudet MJ. (1995). Traitement chirurgical des hemorragies ulcercuses graves: facteurs prédictifs de la mortalité opératoire. Gastroenterol. Clin. Biol. 19(3): 259-265.
Efymenko NA, Lisenko MV, Astashov VL. (2004). Bleeding from chronic gastroduodenal ulcers: modern views and treatment prospects. Khyrurhyia. 3: 56-60.
Ephraim Joseph K, Devane, AM, Abrams GA. (2022). Patient and endoscopic characteristics and clinical outcomes in subjects with non-variceal GI bleeding referred for transarterial embolization: a single-center experience Abdominal Radiology. 47(11): 3883-3891. https://doi.org/10.1007/s00261-022-03650-x; PMid:36031627
Hanzhyi VV. (2005). Surgical tactics for gastroduodenal ectopia complicated by gastrointestinal bleeding. Dys. … doktora med. nauk: 14.00.03. Kyiv: 465.
Imhof M, Ohmann C, Röher HD, Glutig H; Duesuc study group. (2003). Endoscopic versus operative treatment in high-risk ulcer bleeding patients - results of a randomised study. Langenbecks Arch Surg. 387(9-10): 327-336. Epub 2002 Dec 13. https://doi.org/10.1007/s00423-002-0329-3; PMid:12536327
Khaghan N, Holt PR. (2000). Peptic disease in elderly patients. Can J Gastroenterol. 14(11): 922-928. https://doi.org/10.1155/2000/697943; PMid:11125182
Khamaysi I, Gralnek IM. (2013). Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management. Best Pract Res Clin Gastroenterol. 27(5): 633-638. Epub 2013 Sep 25. https://doi.org/10.1016/j.bpg.2013.09.002; PMid:24160923
Khokhlova EE, Zairatyants OV, Tarasova LB, Shepeleva YuA. (2013). Acute gastroduodenal erosive and ulcerative lesions in elderly therapeutic and neurological patients. Clinical gerontology. 3-4: 40-42.
Kubyshkin VA, Petrov DIu, Smirnov AV (2013). Endoscopic hemostasis in the treatment of the gastroduodenal ulcer bleeding. Khirurgiia. (9): 67-72. PMid: 24344436.
Kwon SH, Noh SY, Oh JH. (2023). Interventional radiological approaches to non-variceal gastrointestinal bleeding International. Journal of Gastrointestinal Intervention, 12(1): 37-42. https://doi.org/10.18528/ijgii220005
Laine L, Estrada R. (2002). Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: is local tamponade enough? Gastrointest Endosc. 55(1): 6-10. https://doi.org/10.1067/mge.2002.120390; PMid:11756906
Lee S, Kim T, Han SC, Pak H, Jeon HH. (2022). Transcatheter arterial embolization for gastrointestinal bleeding: Clinical outcomes and prognostic factors predicting mortality Medicine (United States). 101(31): e29342. https://doi.org/10.1097/MD.0000000000029342; PMid:35945735 PMCid:PMC9351940
Mönkemüller KE, Eloubeidi MA. (2002). Bleeding peptic ulcers: what's new? Gastrointest Endosc. 56(1): 153-157; discussion 157-159. PMid: 12108425.
Mykhailov AP, Danylov AM, Napalkov AN. (2005) Features of surgical tactics for ulcerative gastroduodenal bleeding in elderly and senile patients. Vestn. khyrurhyy ym. Y.Y. Hrekova. 164(6): 74-77.
Nussbaum M, Baum S, Blakemore WS, Finkerstein AK. (1965). Demonstration of intra-abdominal bleeding by selective arteriography: visualization of celiac and superior mesenteric arteries. JAMA. 191: 389-390. https://doi.org/10.1001/jama.1965.03080050035009; PMid:14232442
Nykyshyn LF. Popyk MP. (2006). Renthenoэndovaskuliarnaia khyrurhyia (ynterventsyonnaia radyolohyia). Lvov: Lvivska politekhnika: 323.
Porter DH, Kim D. (1997). Angiographic intervention in upper gastrointestinal bleeding. In: Taylor MB. ed. Gastrointestinal emergencies. Williams & Wilkins: 163-180.
Rabkyn YKh, Matevosov AL, Hotman LN. (1987). X-ray endovascular surgery. Guide for doctors. M.: Medytsyna: 416.
Roost I, Zetner D, Rosenberg J, Andresen K. (2022). Prophylactic arterial embolization in patients with bleeding peptic ulcers following endoscopic control of bleeding. Cochrane Database of Systematic Reviews. (6): CD014999. https://doi.org/10.1002/14651858.CD014999; PMCid:PMC9190190
Seewald S, Seitz U, Thonke F, Sriram PV, He XK, Soehendra N. (2001). Interventional endoscopic treatment of upper gastrointestinal bleeding - when, how, and how often. Langenbecks Arch Surg. 386(2): 88-97. https://doi.org/10.1007/s004230100208; PMid:11374053
Seldinger SI. (1953). Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 39(5): 368-376. https://doi.org/10.3109/00016925309136722; PMid:13057644
Sikal MO. (2013). Suspension of X-ray endovascular hemostasis in the complex of surgical treatment of acute scutulo-intestinal bleeding of viral origin. Kharkiv. khirurh shkola. 4(61): 96-98.
Timerbulatov VM, Timerbulatov ShV, Sagitov RB. (2010). Hemostasis in acute gastrointestinal bleeding. Khirurgiia. (3): 20-26. PMid: 20517262.
Walt RP. (1990). Upper gastrointestinal bleeding. In: Pounder RE. Ed. Recent advances in gastroenterology. Edinburgh etc. 8: 101-116.
Xiao W, Zhang Z, Su T, Yang S, Li J, Zhao Y, Jin L. (2023). Clinical model for predicting rebleeding within 30 days after transcatheter arterial embolization for treating acute nonvariceal upper gastrointestinal bleeding. Chinese Journal of Interventional Imaging and Therapy. 20(5): 290-294. doi: 10.13929/j.issn.1672-8475.2023.05.009.
Yang L. (2022). Current Interventional Management of Acute Upper Gastrointestinal Bleeding. Journal of Sichuan University (Medical Science Edition). 53(3):361-366. doi: 10.12182/20220560206.
Zherlov HK. (2003). Current trends in the diagnosis and treatment of gastroduodenal ulcers. Biulleten sybyrskoi medytsyni. 4: 5-14. https://doi.org/10.20538/1682-0363-2003-4-5-14
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