Division of Vascular Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
World J Gastroenterol. 2012 Mar 21;18(11):1191-201. doi: 10.3748/wjg.v18.i11.1191.
Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment, there are still a significant number of patients who require emergency angiography and transcatheter treatment. Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography. Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic and imaging data. If a hemorrhage source is identified, superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications. This is now well-recognized as a viable and safe alternative to emergency surgery. In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding. One must be aware of the various side effects and potential complications associated with this treatment, however, and recognize the high re-bleeding rate. In this article we review the current role of angiography, transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.
尽管大多数急性非静脉曲张性胃肠道出血病例要么自行缓解，要么对药物治疗或内镜治疗有反应，但仍有相当数量的患者需要紧急血管造影和经导管治疗。非侵入性成像（如核闪烁扫描或计算机断层扫描）的评估可以在血管造影前定位出血源和/或确认活动性出血。任何血管造影评估都应从供应最可能出血部位的动脉选择性导管插入开始，这是根据可用的临床、内镜和影像学数据确定的。如果确定了出血源，超选择性导管插入术随后进行经导管微线圈栓塞通常是成功控制出血的最有效方法，同时最大限度地减少潜在并发症。这现在被认为是一种可行和安全的替代紧急手术的方法。在某些情况下，经导管动脉内滴注加压素也可用于控制急性胃肠道出血。然而，必须意识到这种治疗方法的各种副作用和潜在并发症，并认识到高再出血率。本文回顾了血管造影、经导管动脉栓塞和灌注治疗在非静脉曲张性胃肠道出血的评估和治疗中的作用。
