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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Gastrointestinal endoscopy is the undisputed method of choice for achieving hemostasis in the gastrointestinal tract. Provocative angiography has been reported to help in the detection of elusive bleeding.
Research motivation
We discovered contrast extravasation following the application of norepinephrine (NE) in angiographic procedures. Our purpose was to investigate the detection of masked bleeding during NE therapy.
Research objectives
The aim was to describe the procedure for the detection of elusive bleeding under the administration of NE and intensive care therapy.
Research methods
We performed a retrospective analysis of 41 patients with lower gastrointestinal tract bleeding treated by radiological procedures. Four patients received NE during angiography.
Research results
A previously undetected bleed was found in three patients. The bleeding was embolized without complications in two of four patients. In one patient we observed no bleeding after the administration of NE. One patient experienced bowel ischemia and had to be treated surgically.
Research conclusions
Bleeding was discovered in three of four cases. No complications were observed in two of three cases of embolization. Our results suggest that the use of NE may have the potential to improve the angiographic therapy of lower gastrointestinal bleeding in critically ill patients.
Research perspectives
Future studies should be focused on a prospective validation of the procedures described here but with a larger number of patients.
