Characteristics of patients treated for active lower gastrointestinal bleeding detected by CT angiography: Interventional radiology versus surgery

Megan Pannatier; Rafael Duran; Alban Denys; Reto Meuli; Tobias Zingg; Sabine Schmidt

doi:10.1016/j.ejrad.2019.108691

Characteristics of patients treated for active lower gastrointestinal bleeding detected by CT angiography: Interventional radiology versus surgery

Eur J Radiol. 2019 Nov:120:108691. doi: 10.1016/j.ejrad.2019.108691. Epub 2019 Sep 26.

Authors

Megan Pannatier¹, Rafael Duran¹, Alban Denys¹, Reto Meuli¹, Tobias Zingg², Sabine Schmidt³

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: sabine.schmidt@chuv.ch.

PMID: 31589996
DOI: 10.1016/j.ejrad.2019.108691

Abstract

Purpose: To determine radiological or clinical criteria guiding treatment decisions in active lower gastrointestinal bleeding (LGIB).

Materials and methods: We consecutively and retrospectively included all patients admitted to our emergency department for acute LGIB proven by CT angiography (CTA) from 2004 to 2017. Patients were divided into two groups depending on whether they first underwent interventional radiological (IR) or surgical treatment. Two radiologists reviewed CTA and angiographic images. Patients' hemodynamic and clinical parameters, delay between imaging and treatment, procedure characteristics, and outcomes were investigated to detect differences between the two groups.

Results: Initial management consisted of IR in 62 cases (70.5%) and surgery in 26 (29.5%). IR cases were older than surgical cases (74.3 vs 64.3y, p = 0.014). Baseline hemodynamic parameters were similar between the two groups. For colonic bleeding sources, the delay between CTA and IR was shorter than between CTA and surgery (p = 0.027), while there was a trend towards a shorter delay for all LGIB taken together (p = 0.061). In cases with hematochezia or melena, IR was more frequently performed than surgery (p = 0.001). Surgical cases showed higher base excesses (p = 0.039) and lactate levels (p = 0.042) after treatment compared with IR cases. Length of hospital stay was similar between the two groups (p = 0.728). During angiography, 41 (66%) cases were embolized. Complications occurred in three cases after IR (7%) and in five after surgery (19%).

Conclusion: Initial management of active LGIB revealed by CTA (i.e. IR versus surgery), may depend on age and clinical signs, rather than hemodynamic parameters.

Keywords: CT angiography; Digital subtraction angiography; Gastrointestinal hemorrhage; Interventional radiology; Lower gastrointestinal tract; Therapeutic embolization.

Publication types

Comparative Study

MeSH terms

Acute Disease
Aged
Computed Tomography Angiography / methods*
Embolization, Therapeutic / methods*
Female
Gastrointestinal Hemorrhage / diagnostic imaging*
Gastrointestinal Hemorrhage / surgery
Gastrointestinal Hemorrhage / therapy*
Humans
Male
Middle Aged
Radiology, Interventional / methods
Retrospective Studies
Treatment Outcome