Transcatheter embolization versus vasopressin infusion for the control of arteriocapillary gastrointestinal bleeding.

The transcatheter method appropriate for use in the control of arteriocapillary gastrointestinal bleeding is a point of controversy. Intraarterial vasopressin infusion, which has been performed in more than 500 patients at the Massachusetts General Hospital, has achieved control in 90% of patients actively bleeding from the stomach and colon. In view of the severity of hemorrhage and associated illnesses in these patients, the complication rate associated with this method was low. Intraarterial vasopressin infusions were ineffective in pyloroduodenal and postoperative bleeding sites and hemorrhage from abscesses. While embolization can control bleeding in these areas, complications have been shown despite precise selective catheter placement. Because of catheterization difficulties and the permanency of the vascular occlusion, embolization is reserved for patients in whom surgical intervention would be associated with extreme risks.