Diagnose und Therapie gastrointestinaler Blutungen

Andreas H. Mahnken

doi:10.1055/a-1949-7143

Radiologie up2date, Table of Contents

Radiologie up2date 2023; 23(01): 13-29
DOI: 10.1055/a-1949-7143

Abdominelle und gastrointestinale Radiologie

Diagnose und Therapie gastrointestinaler Blutungen

Diagnosis and Therapy of Gastrointestinal Bleeding

Andreas H. Mahnken

Abstract

All articles of this category

Zusammenfassung

Gastrointestinale Blutungen sind komplexe Krankheitsgeschehen mit einer jährlichen Inzidenz von bis zu 100/100 000 Personen, die mit einer Mortalität von etwa 10% einhergehen. Jenseits der Endoskopie sind die kontrastangehobene CT und die interventionell-radiologische Therapie zentrale Bestandteile leitliniengerechter Diagnose- und Therapiealgorithmen.

Abstract

Gastrointestinal bleedings are a complex group of conditions with an annual incidence of up to 100/100 000 and a mortality of approximately 10%. Contrast enhanced computed tomography and interventional radiology treatment are cornerstones of guideline-based diagnosis and therapy beyond endoscopy. This article summarizes the current evidence on radiologic diagnosis and interventional radiologic treatment in the different types of gastrointestinal bleedings.

Schlüsselwörter

Blutung - gastrointestinale Blutung - Computertomografie - CT-Angiografie - Embolisation

Key words

bleeding - gastrointestinal bleeding - computertomography - CT angiography - embolization

Full Text

References

Literatur
1 Hreinsson JP, Kalaitzakis E, Gudmundsson S. et al. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol 2013; 48: 439-447 DOI: 10.3109/00365521.2012.763174.
2 Kurien M, Lobo AJ. Acute upper gastrointestinal bleeding. Clin Med (Lond) 2015; 15: 481-485 DOI: 10.7861/clinmedicine.15-5-481.
3 Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part I: clinical presentation and diagnosis. Gastrointest Endosc 1998; 48: 606-617 DOI: 10.1016/s0016-5107(98)70043-4.
4 Garcia-Tsao G, Sanyal AJ, Grace ND. et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol 2007; 102: 2086-2102 DOI: 10.1111/j.1572-0241.2007.01481.x.
5 Srygley FD, Gerardo CJ, Tran T. et al. Does this patient have a severe upper gastrointestinal bleed?. JAMA 2012; 307: 1072-1079 DOI: 10.1001/jama.2012.253.
6 de Franchis R. Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752 DOI: 10.1016/j.jhep.2015.05.022.
7 Brett BT, Hayes PC, Jalan R. Primary prophylaxis of variceal bleeding in cirrhosis. Eur J Gastroenterol Hepatol 2001; 13: 349-358 DOI: 10.1097/00042737-200104000-00008.
8 Aoki T, Nagata N, Shimbo T. et al. Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2016; 14: 1562-1570.e2 DOI: 10.1016/j.cgh.2016.05.042.
9 Götz M, Anders M, Biecker E. et al. S2k-Leitlinie Gastrointestinale Blutung. Z Gastroenterol 2017; 55: 883-936 DOI: 10.1055/s-0043-116856.
10 Repaka A, Atkinson MR, Faulx AL. et al. Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study. Gastrointest Endosc 2012; 76: 367-373 DOI: 10.1016/j.gie.2012.03.1391.
11 Dulai GS, Jensen DM. Severe gastrointestinal bleeding of obscure origin. Gastrointest Endosc Clin N Am 2004; 14: 101-113 DOI: 10.1016/j.giec.2003.10.017.
12 Zuckier LS. Acute gastrointestinal bleeding. Semin Nucl Med 2003; 33: 297-311 DOI: 10.1016/s0001-2998(03)00033-3.
13 Zuckerman GR, Prakash C, Askin MP. et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 201-221 DOI: 10.1016/s0016-5085(00)70430-6.
14 Baum S, Athanasoulis CA, Waltman AC. et al. Gastrointestinal hemorrhage. II. Angiographic diagnosis and control. Adv Surg 1973; 7: 149-198
15 Rahn 3rd NH, Tishler JM, Han SY. et al. Diagnostic and interventional angiography in acute gastrointestinal hemorrhage. Radiology 1982; 143: 361-366 DOI: 10.1148/radiology.143.2.6978500.
16 Vernava 3rd AM, Moore BA, Longo WE. et al. Lower gastrointestinal bleeding. Dis Colon Rectum 1997; 40: 846-858 DOI: 10.1007/BF02055445.
17 Textor HJ, Wilhelm K, Strunk H. et al. Diagnostik intraabdomineller Blutungen mit CO2 als Kontrastmittel. Rofo 1997; 166: 51-53 DOI: 10.1055/s-2007-1015377.
18 Johnston C, Tuite D, Pritchard R. et al. Use of provocative angiography to localize site in recurrent gastrointestinal bleeding. Cardiovasc Intervent Radiol 2007; 30: 1042-1046 DOI: 10.1007/s00270-007-9107-5.
19 Lee EW, Laberge JM. Differential diagnosis of gastrointestinal bleeding. Tech Vasc Interv Radiol 2004; 7: 112-122 DOI: 10.1053/j.tvir.2004.12.001.
20 Miyakuni Y, Nakajima M, Ohbe H. et al. Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study. Acute Med Surg 2020; 7: e533 DOI: 10.1002/ams2.533.
21 Defreyne L, Vanlangenhove P, De Vos M. et al. Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology 2001; 218: 739-748 DOI: 10.1148/radiology.218.3.r01mr05739.
22 Kwon JH, Kim MD, Han K. et al. Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study. Eur Radiol 2019; 29: 57-67 DOI: 10.1007/s00330-018-5587-8.
23 Melson GL, Geisse G, Stanley RJ. Selective intraarterial infusion of vasopressin for control of gastrointestinal bleeding: experience with 35 cases. Gastrointest Radiol 1976; 1: 59-65 DOI: 10.1007/BF02256343.
24 Madoff DC, Wallace MJ, Lichtiger B. et al. Intraarterial platelet infusion for patients with intractable gastrointestinal hemorrhage and severe refractory thrombocytopenia. J Vasc Interv Radiol 2004; 15: 393-397 DOI: 10.1097/01.rvi.0000123318.06419.93.
25 Chang WC, Liu CH, Hsu HH. et al. Intra-arterial treatment in patients with acute massive gastrointestinal bleeding after endoscopic failure: comparisons between positive versus negative contrast extravasation groups. Korean J Radiol 2011; 12: 568-578 DOI: 10.3348/kjr.2011.12.5.568.
26 Tarasconi A, Baiocchi GL, Pattonieri V. et al. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg 2019; 14: 3 DOI: 10.1186/s13017-019-0223-8.
27 Dobritz M, Engels HP, Schneider A. et al. Evaluation of dual-phase multi-detector-row CT for detection of intestinal bleeding using an experimental bowel model. Eur Radiol 2009; 19: 875-881 DOI: 10.1007/s00330-008-1205-5.
28 Mohammadinejad P, Kwapisz L, Fidler JL. et al. The utility of a dual-phase, dual-energy CT protocol in patients presenting with overt gastrointestinal bleeding. Acta Radiol Open 2021; 10 DOI: 10.1177/20584601211030658.
29 Feingold DL, Pappou EP, Lee-Kong SA. Diagnostic Modalities in Gastrointestinal Bleeding. Clin Colon Rectal Surg 2020; 33: 5-9 DOI: 10.1055/s-0039-1693440.
30 García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A. et al. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013; 23: 1181-1190 DOI: 10.1007/s00330-012-2721-x.
31 Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. J Med Imaging Radiat Oncol 2008; 52: 333-338 DOI: 10.1111/j.1440-1673.2008.01964.x.
32 Wu LM, Xu JR, Yin Y. et al. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol 2010; 16: 3957-3963 DOI: 10.3748/wjg.v16.i31.3957.
33 He B, Yang J, Xiao J. et al. Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis. Eur J Radiol 2017; 93: 40-45 DOI: 10.1016/j.ejrad.2017.05.020.
34 He B, Yang J, Xiao J. et al. Accuracy of Computed Tomographic Enterography for Obscure Gastrointestinal Bleeding: A Diagnostic Meta-analysis. Acad Radiol 2018; 25: 196-201 DOI: 10.1016/j.acra.2017.09.001.
35 Wang Z, Chen JQ, Liu JL. et al. CT enterography in obscure gastrointestinal bleeding: a systematic review and meta-analysis. J Med Imaging Radiat Oncol 2013; 57: 263-273 DOI: 10.1111/1754-9485.12035.
36 Kennedy DW, Laing CJ, Tseng LH. et al. Detection of active gastrointestinal hemorrhage with CT angiography: a 4(1/2)-year retrospective review. J Vasc Interv Radiol 2010; 21: 848-855 DOI: 10.1016/j.jvir.2010.01.039.
37 Martí M, Artigas JM, Garzón G. et al. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology 2012; 262: 109-116 DOI: 10.1148/radiol.11110326.
38 Hilfiker PR, Weishaupt D, Kacl GM. et al. Comparison of three dimensional magnetic resonance imaging in conjunction with a blood pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding. Gut 1999; 45: 581-587 DOI: 10.1136/gut.45.4.581.
39 Erden A, Bozkaya H, Türkmen Soygür I. et al. Duodenal angiodysplasia: MR angiographic evaluation. Abdom Imaging 2004; 29: 12-14 DOI: 10.1007/s00261-003-0077-z.
40 Casciani E, Nardo GD, Chin S. et al. MR Enterography in paediatric patients with obscure gastrointestinal bleeding. Eur J Radiol 2017; 93: 209-216 DOI: 10.1016/j.ejrad.2017.05.044.