Provocative angiography in obscure gastrointestinal bleeding

Obscure gastrointestinal (GI) bleeding is relatively common but difficult t o manage. By definition, diagnosis of a specific etiology is particularly c hallenging. We report the diagnostic use of provocative angiography in a pa tient with recurrent obscure GI bleeding. Although provocative angiography led to localization of bleeding and allowed specific treatment (placement o f a 2-mm long, 0.010-inch diameter platinum coil, resulting in cessation of bleeding for 2 months), ultimately, the use of provocative angiography del ayed specific diagnosis in our patient. We conclude that provocative angiog raphy is a potentially powerful adjunct in the management of obscure GI ble eding, but that caution is required when using it. Provocative angiography should be reserved for patients who have had adequate imaging studies with negative results.