Provocative angiography in patients with gastrointestinal hemorrhage of obscure origin

OBJECTIVE: A standard diagnostic evaluation including upper and/or lower en doscopy, tagged red blood cell scintigraphy, and visceral angiography ident ifies the source of GI bleeding in the majority of patients who present wit h acute GI hemorrhage. However, in a small group of patients the source of bleeding remains obscure; this form of GI hemorrhage is uncommon but repres ents a considerable diagnostic challenge. Some investigators have advocated provocation of bleeding with vasodilators, anticoagulants, and/or thrombol ytics in association with tagged red blood cell scans or angiography. Unfor tunately, the available literature on this topic is limited. Therefore, the purpose of this study is to report our experience with provocative GI blee ding studies. METHODS: The radiology databases at Duke University Medical Center and the Durham Veterans Administration Medical Center were reviewed from 1994 to 19 99. Any patient who received a vasodilator, anticoagulant, or thrombolytic to induce bleeding during a tagged red blood cell scan or visceral angiogra m was included. RESULTS: Seven provocative bleeding studies were performed on seven patient s. All patients underwent a visceral angiogram with intra-arterial administ ration of tolazoline (a vasodilator), heparin (an anticoagulant), and/or ur okinase (a thrombolytic). Of the seven provocative studies, only two induce d angiographically identifiable bleeding. Both of these patients underwent surgical therapy. There were no complications attributed to the provocative bleeding studies. CONCLUSIONS: These results suggest that provocative GI bleeding studies can be performed safely. However, because an active bleeding source was identi fied in only a small proportion of patients, we believe that further study is required to optimize patient selection and to clarify the cost-effective ness of this approach in patients with GI hemorrhage of obscure origin. (Am J Gastroenterol 2000,95: 2807-2812. (C) 2000 by Am. Coll. of Gastroenterol ogy).