Millward Steven F
University of Western Ontario, London, and Peterborough Regional Health Centre, Peterborough Ontario, Canada.
J Am Coll Radiol. 2008 Apr;5(4):550-4. doi: 10.1016/j.jacr.2008.01.010.
Acute upper gastrointestinal (UGI) tract bleeding is best initially investigated and treated with endoscopy. For patients who fail therapeutic endoscopy, both surgery and transcatheter arteriography and intervention (TAI) are equally effective. Transcatheter arteriography and intervention should be considered as a treatment option in patients with UGI bleeding, particularly those at high risk for surgery. Transcatheter arteriography and intervention for UGI bleeding has a low rate of major complications, and prolonged clinical success is seen in at least 65% of patients. Transcatheter arteriography and intervention is the best method of treatment for bleeding occurring into the biliary tree or pancreatic duct. In patients with acute lower gastrointestinal (LGI) tract bleeding who are hemodynamically stable, either colonoscopy or nuclear medicine scans can be used for diagnosis. Colonoscopy will identify the site of bleeding more frequently than other methods and can provide effective treatment. The use of emergent TAI is most appropriate for patients with massive LGI bleeding, because contrast extravasation is more likely to be seen on diagnostic arteriography, and this can then guide therapeutic embolization. Transcatheter arteriography and intervention may successfully stop bleeding in 40% to 85% of patients. Major complications from TAI are uncommon, but the risk for rebleeding is quite high, particularly when LGI bleeding originates from the jejunum, ileum, or cecum. Transcatheter arteriography and intervention is most effective for the treatment of bleeding from colonic diverticulitis and for bleeding occurring distal to the cecum. The choice of colonoscopy, TAI, or surgery for hemodynamically unstable patients with acute LGI bleeding will depend on institutional expertise and whether the site of bleeding has been localized.
急性上消化道（UGI）出血最初最好通过内镜检查进行诊断和治疗。对于治疗性内镜检查失败的患者，手术和经导管动脉造影及介入治疗（TAI）同样有效。对于UGI出血患者，尤其是手术高危患者，应考虑将经导管动脉造影及介入治疗作为一种治疗选择。UGI出血的经导管动脉造影及介入治疗主要并发症发生率低，至少65%的患者有长期临床疗效。经导管动脉造影及介入治疗是治疗胆道或胰管出血的最佳方法。对于血流动力学稳定的急性下消化道（LGI）出血患者，结肠镜检查或核医学扫描均可用于诊断。结肠镜检查比其他方法更能频繁地确定出血部位，并能提供有效的治疗。紧急TAI最适合于大量LGI出血的患者，因为在诊断性动脉造影中更可能看到造影剂外渗，进而可指导治疗性栓塞。经导管动脉造影及介入治疗可使40%至85%的患者成功止血。TAI的主要并发症并不常见，但再出血风险相当高，尤其是当LGI出血源自空肠、回肠或盲肠时。经导管动脉造影及介入治疗对结肠憩室炎出血和盲肠远端出血的治疗最为有效。对于血流动力学不稳定的急性LGI出血患者，选择结肠镜检查、TAI还是手术，将取决于机构的专业水平以及出血部位是否已定位。
