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Der Chirurg

, Volume 77, Issue 2, pp 117–125 | Cite as

Gastrointestinale Blutung

Interventionell-radiologische Diagnostik und Therapie
  • M. WingenEmail author
  • R. W. Günther
Leitthema

Zusammenfassung

Moderne bildgebende Verfahren wie die (Mehrzeilen-)Spiral-CT haben neue Möglichkeiten in der Diagnostik von gastrointestinalen Blutungen geschaffen. Mit der superselektiven Transkatheterembolisation oder der TIPS-Anlage stehen auch interventionell-radiologische Therapieansätze zur Verfügung, die operative Verfahren ergänzen oder ggf. ersetzen können. Dieser Beitrag gibt eine Übersicht über die Möglichkeiten und den Stellenwert der aktuellen diagnostischen und therapeutischen interventionell-radiologischen Verfahren. Welche Verfahren jeweils zum Einsatz kommen, sollten Gastroenterologe, Chirurg und Radiologe in Abhängigkeit von lokaler Verfügbarkeit, persönlicher Erfahrung und Patientenfaktoren interdisziplinär im Einzelfall entscheiden.

Schlüsselwörter

Gastrointestinale Blutung Radiologische Diagnostik Interventionelle Radiologie Embolisation Spiral-CT 

Gastrointestinal bleeding

Diagnostics and therapy by interventional radiology

Abstract

Modern imaging modalities such as (multislice) helical CT allow new diagnostic strategies for gastrointestinal hemorrhage. Today, interventional radiology with superselective transcatheter embolization or TIPS procedures allow minimally invasive therapeutic management which can support or replace surgery. This review is a synopsis of the possibilities and relative merits of diagnostic and therapeutic radiological procedures for gastrointestinal bleeding. Which of them to use should be decided collaboratively by gastroenterologist, surgeon, and radiologist depending on local availability, personal experience, and individual patient factors.

Keywords

Gastointestinal bleeding Diagnostics Interventional radiology Embolization Helical computed tomography 

Notes

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Literatur

  1. 1.
    Alavi A, Dann RW, Baum S, Biery DN (1977) Scintigraphic detection of acute gastrointestinal bleeding. Radiology 124:753PubMedGoogle Scholar
  2. 2.
    Antes G, Neher M, Hiemeyer V, Burger A (1996) Gastrointestinal bleeding of obscure origin: Role of enteroclysis. Eur Radiol 6:851CrossRefPubMedGoogle Scholar
  3. 3.
    Athanasoulis CA, Baum S, Rosch J et al. (1975) Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis. Am J Surg 129:212CrossRefPubMedGoogle Scholar
  4. 4.
    Baum S, Athanasoulis CA, Waltman AD, Ring EJ (1973) Gastrointestinal hemorrhage. II. Angiographic diagnosis and control. Adv Surg 7:149PubMedGoogle Scholar
  5. 5.
    Bandi R, Shetty PC, Sharma P, Burke TH et al. (2001) Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 12:1399PubMedGoogle Scholar
  6. 6.
    Bonacker MJ, Begemann, PGC, Dieckmann C, Yekebas E, Adam G (2003) Stellenwert der Angiographie in der Diagnose und Therapie gastrointestinaler Blutungen. Fortschr Röntgenstr 175:524Google Scholar
  7. 7.
    Bookstein JJ, Chlosta EM, Foley D, Walter JF (1974) Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology 113:277PubMedGoogle Scholar
  8. 8.
    Chan FP, Chhor CM (2003) Active lower gastrointestinal hemorrhage diagnosed by magnetic resonance angiography: case report. Abdom Imaging 28:637CrossRefPubMedGoogle Scholar
  9. 9.
    Clark RA, Colley DP, Eggers FM (1981) Acute arterial gastrointestinal hemorrhage: efficacy of transcatheter control. AJR 136:1185PubMedGoogle Scholar
  10. 10.
    Darcy M (2003) Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol 14:535PubMedGoogle Scholar
  11. 11.
    Dixon PM, Roulston ME, Nolan DJ (1993) The small bowel enema: a ten year review. Clin Radiol 47:46PubMedGoogle Scholar
  12. 12.
    Ernst O, Bulois P, Saint-Drenant S et al. (2003) Helical CT in akute lower gastrointestinal bleeding. Eur Radiol 13:114PubMedGoogle Scholar
  13. 13.
    Ettore GC, Francisos G, Garriba AP et al. (1997) Helical CT angiography in gastrointestinal bleeding of obscure origin. Am J Roentgenol 168:727Google Scholar
  14. 14.
    Evangelista PT, Hallisey MJ (2000) Transcatheter embolization for acute lower gastrointestinal hemorrhage. J Vasc Interv Radiol 11:601PubMedGoogle Scholar
  15. 15.
    Funaki B, Kostelic JK, Lorenz J et al. (2001) Superselective microcoil embolization of colonic hemorrhage. AJR 177:829PubMedGoogle Scholar
  16. 16.
    Funaki B (2004) Microkatheter embolization of lower gastrointestinal hemorrhage: an old idea whose time has come. Cardiovasc Intervent Radiol 27:591CrossRefPubMedGoogle Scholar
  17. 17.
    Gomes AS, Lois JF, McCoy RD (1986) Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR 146:1031PubMedGoogle Scholar
  18. 18.
    Hilfiker, PR, Weishaupt D, Kacl GM et al. (1999) Comparison of three dimensional magnetic resonance imaging in conjunction with a blodd pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding. Gut 45:581PubMedGoogle Scholar
  19. 19.
    Jacobson AF, Cerqueira MD (1992) Prognostic significance of late imaging results in technetium99m labeled red blood cell gastrointestinal bleeding studies with early negative images. J Nucl Med 33:202PubMedGoogle Scholar
  20. 20.
    Johnson WC, Widrich WC (1976) Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage. Am J Surg 131:481CrossRefPubMedGoogle Scholar
  21. 21.
    Kuo WT, Lee DE, Saad WEA et al. (2003) Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 14:1503PubMedGoogle Scholar
  22. 22.
    Lau WY, Ngan H, Chu KW, Yuen WK (1989) Repeat selective visceral angiography in patients with gastrointestinal bleeding of obscure origin. Br J Surg 76:226PubMedGoogle Scholar
  23. 23.
    Layer G (2003) Radiologische Verfahren bei gastrointestinaler Blutung — Diagnostik. Dtsch Med Wochenschr 128:2074CrossRefPubMedGoogle Scholar
  24. 24.
    Mandel J, Bond J, Bradley M et al. (1989) Sensitivity, specificity and positive predictive vale of the hemoccult test in screening for colorectal cancers. The University of Minnesota’s colon cancer control study. Gastroenterology 97:597PubMedGoogle Scholar
  25. 25.
    Moch A, Herlinger H, Kochmann ML et al. (1994) Enteroclysis in the evaluation of obscure gastrointestinal bleeding. Am J Roentgenol 163:1381Google Scholar
  26. 26.
    Pennoyer WP, Vignati PV, Cohen JL (1996) Mangement of angiogram positive lower gastrointestinal hemorrhage: long term follow-up of non-operative treatments. Int J Colorectal Dis 11:279CrossRefPubMedGoogle Scholar
  27. 27.
    Pichon N, Francois B, Pichon-Lefievre F et al. (2005) Embolization of rectal arteries: an alternative treatment for hemorrhagic shock induced by intrarectal hemorrhage. Cardiovasc Intervent Radiol 28:515CrossRefPubMedGoogle Scholar
  28. 28.
    Rajan R, Dhar P, Praseedom RK, Sudhindran S, Moorthy S (2004) Role of contrast CT in acute lower gastrointestinal bleeding. Dig Surg 21:293CrossRefPubMedGoogle Scholar
  29. 29.
    Ripoll C, Banares R, Beceiro I et al. (2004) Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol 15:447PubMedGoogle Scholar
  30. 30.
    Rössle M, Haag K, Ochs A et al. (1994) The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 330:165CrossRefPubMedGoogle Scholar
  31. 31.
    Rosch J, Dotter CT, Antonovic R (1972) Selective vasoconstrictor infusion in the management of arterio-capillary gastrointestinal hemorrhage. AJR 116:279Google Scholar
  32. 32.
    Ryan JM, Key SM, Dumbleton SA, Smith TP (2001) Nonlocalized lower gastrointestinal bleeding: Provocative bleeding studies with intraarterial tPA, Heparin, and Tolazoline. J Vasc Interv Radiol 12:1273PubMedGoogle Scholar
  33. 33.
    Schenker MP, Duszak R, Soulen MC et al. (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinicl and technical factors impacting success and survival. J Vasc Interv Radiol 12:1263PubMedGoogle Scholar
  34. 34.
    Schürmann K, Bücker A, Jansen M et al. (2002) Selektive CT-Mesenterikographie zur Diagnostik schwerer Darmblutungen unklaren Ursprungs: Vorläufige Ergebnisse. Fortschr Röntgenstr 174:444Google Scholar
  35. 35.
    Sherman LM, Shenoy SS, Cerra FB (1979) Selective intra-arterial vasopressin: clinical efficacy and complications. Ann Surg 189:298PubMedGoogle Scholar
  36. 36.
    Smith R, Copely DJ, Bolen FH (1987) 99MTcTBC scintigraphy: Correlation of gastrointestinal bleeding rates with scintigraphic findings. Am J Roentgenol 148:869Google Scholar
  37. 37.
    Tew K, Davies RP, Jadun CK, Kew J (2004) MDCT of acute lower gastrointestinal bleeding. AJR 182:427PubMedGoogle Scholar
  38. 38.
    Waltman AC (1980) Transcatheter embolization versus vasopressin infusion for the control of arteriocapillary gastrointestinal bleeding. Cardiovasc Intervent Radiol 3:289PubMedGoogle Scholar
  39. 39.
    Zuckerman GR, Prakash C (1998) Acute lower intestinal bleeding. Part I: Clinical presentation and diagnosis. Gastrointest Endosc 48:606CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Klinik für Radiologische Diagnostik, Universitätsklinikum AachenMedizinische Fakultät der Rheinisch-Westfälischen Technischen Hochschule
  2. 2.Klinik für Radiologische DiagnostikUniversitätsklinikum AachenAachen

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