Diagnosis and percutaneous treatment of gastrointestinal hemorrhage. Long-term experience

OBJECTIVE: to report our experience in the diagnosis and treatment of gastr ointestinal hemorrhage. METHOD: from April 1987 to April 1997, 196 patients with gastrointestinal h emorrhage (134 men and 62 women) were studied. 165 (84%) were diagnosed as presenting upper gastrointestinal hemorrhage, and 31 (16%) presented lower gastrointestinal hemorrhage. The patients were studied with endoscopy and a rteriography, and embolization was prescribed in 131 (67%). Patients with b leeding from esophageal varices were excluded from this study. RESULTS: a bleeding point was identified angiographically in 33% (n = 65) p atients. 131 (67%) patients were treated with therapeutic embolization, whi ch was successful in 89% (n = 116) patients. The bleeding was resolved in 8 0% (n = 93) of the patients. Complications included arterial spasm (n = 12) , pain (n = 24), coil migration (n = 8), allergic reaction (n = 2) and celi ac trunk dissection (n = 2). During follow-up 16 patients presented rebleed ing that stopped after reembolization in 9 cases, whereas in 7 cases surger y was needed. CONCLUSIONS: in our experience, diagnostic angiography and percutaneous the rapeutic embolization are effective, less aggressive methods that lead to f ew complications. Both methods have become indispensable tools in managing patients with gastrointestinal hemorrhage that does not respond to conserva tive therapy. Even in patients with no evidence of angiographic bleeding, e mbolization in selected patients is successful.