Bloomfeld R S, Smith T P, Schneider A M, Rockey D C
Department of Medicine and Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Am J Gastroenterol. 2000 Oct;95(10):2807-12. doi: 10.1111/j.1572-0241.2000.03191.x.
A standard diagnostic evaluation including upper and/or lower endoscopy, tagged red blood cell scintigraphy, and visceral angiography identifies the source of GI bleeding in the majority of patients who present with acute GI hemorrhage. However, in a small group of patients the source of bleeding remains obscure; this form of GI hemorrhage is uncommon but represents a considerable diagnostic challenge. Some investigators have advocated provocation of bleeding with vasodilators, anticoagulants, and/or thrombolytics in association with tagged red blood cell scans or angiography. Unfortunately, the available literature on this topic is limited. Therefore, the purpose of this study is to report our experience with provocative GI bleeding studies.
The radiology databases at Duke University Medical Center and the Durham Veterans Administration Medical Center were reviewed from 1994 to 1999. Any patient who received a vasodilator, anticoagulant, or thrombolytic to induce bleeding during a tagged red blood cell scan or visceral angiogram was included.
Seven provocative bleeding studies were performed on seven patients. All patients underwent a visceral angiogram with intra-arterial administration of tolazoline (a vasodilator), heparin (an anticoagulant), and/or urokinase (a thrombolytic). Of the seven provocative studies, only two induced angiographically identifiable bleeding. Both of these patients underwent surgical therapy. There were no complications attributed to the provocative bleeding studies.
These results suggest that provocative GI bleeding studies can be performed safely. However, because an active bleeding source was identified in only a small proportion of patients, we believe that further study is required to optimize patient selection and to clarify the cost-effectiveness of this approach in patients with GI hemorrhage of obscure origin.
标准的诊断评估包括上消化道和/或下消化道内镜检查、标记红细胞闪烁扫描及内脏血管造影，可确定大多数急性胃肠道出血患者的出血源。然而，一小部分患者的出血源仍不明确；这种胃肠道出血形式虽不常见，但却是一个相当大的诊断挑战。一些研究者主张在标记红细胞扫描或血管造影时，使用血管扩张剂、抗凝剂和/或溶栓剂诱发出血。遗憾的是，关于这一主题的现有文献有限。因此，本研究的目的是报告我们在诱发胃肠道出血研究方面的经验。
回顾了1994年至1999年杜克大学医学中心和达勒姆退伍军人管理局医学中心的放射学数据库。纳入所有在标记红细胞扫描或内脏血管造影期间接受血管扩张剂、抗凝剂或溶栓剂以诱发出血的患者。
对7例患者进行了7次诱发出血研究。所有患者均接受了内脏血管造影，并经动脉注射妥拉唑啉（一种血管扩张剂）、肝素（一种抗凝剂）和/或尿激酶（一种溶栓剂）。在这7次诱发研究中，只有2次诱发出血管造影可识别的出血。这两名患者均接受了手术治疗。诱发出血研究未导致任何并发症。
这些结果表明，诱发胃肠道出血研究可安全进行。然而，由于仅一小部分患者中识别出了活动性出血源，我们认为需要进一步研究以优化患者选择，并阐明这种方法在不明原因胃肠道出血患者中的成本效益。
