What is gastro-intestinal bleeding?

Bleeding from the gastro-intestinal tract is a common clinical condition. It could be from the upper gastro-intestinal tract (esophagus, stomach and duodenum) or from the lower gastro-intestinal tract (small and large intestine). According to the site of bleeding, several risk factors can be involved. Patients can present vomiting blood (hematemesis), passing bright red blood with stool (hematochezia) or passing dark red blood with stool (melena). Any form ofgastrointestinal tract bleeding is a serious presentation that should be thoroughly investigated and carefully managed.

How can gastro-intestinal bleeding be detected?

The clinical presentation (hematemsis, hematochezia, melena) by itself can help to detect acute gastro-intestinal bleeding. Thorough and complete medical background checkup can also help to detect the risk factors and medical conditions that can predispose to gastro-intestinal bleeding, such as, history of chronic liver disease, peptic ulcer disease, inflammatory bowel disease, etc. In case of severe gastro-intestinal bleeding, the patient’s vital signs would be unstable requiring urgent interventions. Other means to detect gastro-intestinal bleeding include laboratory work such as hemoglobin level and complete blood analysis, liver function tests. Radiological studies play a pivotal rule in detecting the source of acute gastro-intestinal bleeding and mapping the arterial tree for the interventional radiologist.

What is an embolization procedure?

Embolization procedures are one of the major techniques in the armamentarium of interventional radiology. They are a common and essential procedures. Using minimally invasive approaches, an artery or a vein can be blocked using different kind of liquid or solid materials. Some of the applications of these procedures are to stop bleeding, treat congenital vascular malformations, stop tumor growth in the liver, treat an aneurysm, treat uterine fibroids, etc.

How is the embolization procedure performed?

After deciding to perform an embolization by the managing medical team, an interventional radiologist will approach the patient to explain the procedure, benefits and risks*. A written consent is obtained*. The patient will be shifted to an interventional radiology suite. Under sterile conditions and local anesthesia*, a femoral or radial vascular access is performed. Using this access, catheters and wires are advanced till reaching the source of the bleeding. Using embolization material, the source of the bleeding is blocked, and any other site of bleeding is stopped. The embolization material to be used will be decided by the interventional radiologist performing the case and he/she might as well discuss it with the patient.

 

*in certain conditions, the patient might be intubated and unconscious, the procedure explanation, the written consent will be explained to his/her next of ken. It will be performed under general anaesthesia or conscious sedation.

How can acute gastro-intestinal bleeding be managed?

Acute gastro-intestinal bleeding is a serious medical condition. If the patient is clinically stable, a team work of emergency physicians andGastroenterologists is required to diagnose and manage such cases. In upper tract bleeding, endoscopy is performed by the gastroenterologist as many of the causes of upper tract bleeding can be managed by endoscopic interventions. In lower tract bleeding, some of the causes can be managed endoscopically.
If the patient is unstable, a team work of emergency physicians, gastroenterologists and intensivists is required to stabilize the patient, help to diagnose and maintain his/her stability.  Once stabilized, again endoscopy plays an integral rule in managing such conditions.

However, in many circumstances, endoscopic techniques are limited. Hereon, radiology and interventional radiology steps in. Using computerized tomographic angiography (CTA), the source of the bleeding can be detected, and the arterial map is outlined. Using these data, the interventional radiologist can reach the source of the bleeding and uses materials to block the artery. A procedure called embolization of acute gastro-intestinal bleeding

What are the risks associated with this procedure?

Interventional radiology procedures are minimally invasive procedures with no surgical wound complications. Embolization of acute gastro-intestinal bleeding is generally safe and can be performed more than once for the same patient. If any risks are associated with these procedures, they would be similar to any other interventional procedure such as bleeding from the vascular access site and infection introduction.

What to expect from the embolization procedure?

Embolization for acute gastro-intestinal bleeding is an effective and definitive treatment. Once the source of the bleeding is blocked, the patient is stabilized and the his/her clinical condition improves dramatically.

In some situations, the source of bleeding cannot be identified, even if it was detected in the CTA. A safe approach to such conditions would to bring the patient back again once the bleeding re develops.

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