Dig Dis Interv 2017; 01(S 04): S1-S20
DOI: 10.1055/s-0038-1641654
Poster Presentations
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Provocative Gastrointestinal Hemorrhage

Teodora Bochankova
1  University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Lisa Walker
1  University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Divya Kumari
1  University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Mohammed Al-Natour
1  University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Indravadan Patel
1  University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
22 March 2018 (online)

 

Introduction The detection and treatment of gastrointestinal (GI) bleeding continues to improve in recent years through endoscopic and endovascular techniques. Nonetheless, occult or obscure GI bleeding in cases where initial work-up is negative or non-diagnostic remains a challenge. Employing strategies that provoke bleeding to facilitate diagnosis in these problematic situations can lead to earlier detection and treatment of both acute and chronic GI hemorrhage.

Content Organization Discussion of indications and rational for provocative intervention in gastrointestinal hemorrhage.

  • Description of procedural technique and pharmacological agents used.

    • Example of our institutional protocol is provided with use of intravenous (IV) heparin, intra-arterial nitroglycerin, and tissue plasminogen activator (tPA).

  • Explanation of special procedural considerations, complications and contraindications.

  • Case Examples

    • Lower GI hemorrhage due to sigmoid diverticulosis with failed endoscopic treatment.

      • ▪ Description of vasospasm as an indirect sign of hemorrhage.

      • ▪ Provocative hemorrhage after injection of intra-arterial nitroglycerin.

      • ▪ Successful inferior mesenteric artery coil embolization.

    • Upper GI hemorrhage due to gastritis with negative upper endoscopy, colonoscopy, capsule enterography, and Meckel’s nuclear medicine scan.

      • ▪ Provocative angiography with IV heparin, intra-arterial nitroglycerin, and tPA.

      • ▪ Successful gastroduodenal artery coil embolization.

    • Complications following provocative intervention for lower GI hemorrhage.

      • ▪ Hypotension requiring resuscitation and systemic heparin reversal.

Learning Points

  • To provide an overview of occult GI bleeding and rational/indication for provocative endovascular intervention.

  • To discuss the procedural technique and pharmacologic options for provocative GI hemorrhage.

  • To describe potential complications and contraindications to provocative GI bleeding interventions.

  • To illustrate case examples from our own institution.