Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2022; 14(12): 375-383
Published online Dec 28, 2022. doi: 10.4329/wjr.v14.i12.375
Unmasking lower gastrointestinal bleeding under administration of norepinephrine
David John Werner, Nicolai Wenzel, Nael Abusalim, Ralf Kiesslich, Till Baar, Achim Tresch, Johannes Wilhelm Rey
David John Werner, Nicolai Wenzel, Nael Abusalim, Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
David John Werner, Radiologie Rhein-Nahe, Krankenhaus St. Marienwörth, Bad Kreuznach 55543, Rheinland-Pfalz, Germany
Nael Abusalim, Department of Diagnostic and Interventional Radiology, Medical Center Hanau, Hanau 63450, Hessen, Germany
Ralf Kiesslich, Johannes Wilhelm Rey, Department of Internal Medicine II, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
Till Baar, Achim Tresch, Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne 50923, Nordrhein-Westfalen, Germany
Johannes Wilhelm Rey, Department of Gastroenterology and Endoscopy, Medical Center Osnabrueck, Osnabrueck 49076, Niedersachsen, Germany
Author contributions: Rey JW and Werner DJ designed the topic and wrote the paper; Wenzel N collected the data and edited the text; Baar T and Tresch A performed data analysis; Kiesslich R performed endoscopy and Abusalim N performed interventional angiography.
Institutional review board statement: The study was reviewed and approved by the Ethik-Komission bei der Landesärztekammer Hessen Institutional Review Board (Approval No. FF95/2017).
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: If there is a need, you can contact the corresponding author to share data at any time.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Johannes Wilhelm Rey, MD, PhD, Chief Doctor, Department of Gastroenterology and Endoscopy, Medical Center Osnabrueck, Am Finkenhügel 1, Osnabrueck 49076, Niedersachsen, Germany. johannes.wilhelm.rey@t-online.de
Received: September 9, 2022
Peer-review started: September 9, 2022
First decision: October 12, 2022
Revised: October 24, 2022
Accepted: December 1, 2022
Article in press: December 1, 2022
Published online: December 28, 2022
Processing time: 103 Days and 23.2 Hours
Abstract
BACKGROUND

Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding. Contrast extravasation is a prerequisite for successful embolization. Provocative angiography is helpful in the detection of elusive bleeding.

AIM

We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies, as well as the role of norepinephrine (NE) in unmasking bleeding.

METHODS

We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 years. All patients had a positive shock index and needed intensive care.

RESULTS

In three of four patients, angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic stabilization.

CONCLUSION

We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful embolization. However, this statement must be confirmed in prospective studies.

Keywords: Lower gastrointestinal bleeding; Endoscopy; Provocative angiography; Norepinephrine; Radiology; Gastrointestinal bleeding

Core Tip: Bleeding in the gastrointestinal tract is common in hospital emergency settings. Gastrointestinal endoscopy is currently the undisputed method of choice for achieving hemostasis. Provocative angiography has been reported to help in the detection of elusive bleeding. We performed a retrospective analysis of angiographic management of bleeding in the lower gastrointestinal tract (LGIB). In a small number of patients, hemodynamic stabilization with norepinephrine (NE) disclosed LGIB which had escaped detection until this time. Angiography after administration of NE unmasked bleeding in three of four patients. We saw no complications in two of three patients after embolization. It may be assumed that this method can detect bleeding successfully and help to achieve hemostasis by angiography.