Published online Dec 28, 2022. doi: 10.4329/wjr.v14.i12.375
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
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.
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.
The aim was to describe the procedure for the detection of elusive bleeding under the administration of NE and intensive care therapy.
We performed a retrospective analysis of 41 patients with lower gastrointestinal tract bleeding treated by radiological procedures. Four patients received NE during angiography.
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.
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.
Future studies should be focused on a prospective validation of the procedures described here but with a larger number of patients.