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Upper Gastrointestinal Hemorrhage
John Werner, MD; Christos Georgiades, MD, PhD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Upper gastrointestinal (UGI) hemorrhage
              • Hemorrhage in territory supplied by celiac artery
              • Boundary between UGI and lower gastrointestinal hemorrhage
                • Celiac artery-superior mesenteric artery (SMA) watershed zone
                • Near ligament of Treitz
              • Some hemorrhages can be supplied by both celiac artery and SMA
                • Specifically 2nd and 3rd portions of duodenum
              • Upper and mid esophagus is supplied by short aortic branches
              • Lower esophagus is supplied by left gastric artery
            • Epidemiology
              • ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
                • > 80% have UGI source
              • Prior to introduction of endoscopic/endovascular treatments, mortality was 25%
              • Since introduction of endoscopic/endovascular treatments, mortality has dropped to 5%
            • Causes of UGI hemorrhage
              • ~ 70% of UGI hemorrhage are due to gastric or duodenal ulcer disease of erosive gastritis/duodenitis
              • Secondary causes of UGI hemorrhage
                • ~ 6% Mallory-Weiss tear
                • ~ 4% cancer
                • ~ 20% other

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Equipment Preparation

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          • Things to Avoid

                            OUTCOMES

                            • Problems

                              • Complications

                                • Expected Outcome

                                  Selected References

                                  1. Aquarius M et al: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol. 27(9):1011-6, 2015
                                  2. Loffroy R et al: Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 96(7-8):731-44, 2015
                                  3. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                  4. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
                                  5. Huang YS et al: Transcatheter arterial embolization with N-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically unstable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol. 25(12):1850-7, 2014
                                  6. Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
                                  7. Mejaddam AY et al: Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. J Trauma Acute Care Surg. 75(3):398-403, 2013
                                  8. El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
                                  9. Angle JF et al: Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21(10):1479-86, 2010
                                  10. van Leerdam ME: Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):209-24, 2008
                                  11. van Leerdam ME et al: Acute upper GI bleeding: did anything change? time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 98(7):1494-9, 2003
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Preprocedure

                                      • Procedure

                                        • Post Procedure

                                          TERMINOLOGY

                                          • Definitions

                                            • Upper gastrointestinal (UGI) hemorrhage
                                              • Hemorrhage in territory supplied by celiac artery
                                              • Boundary between UGI and lower gastrointestinal hemorrhage
                                                • Celiac artery-superior mesenteric artery (SMA) watershed zone
                                                • Near ligament of Treitz
                                              • Some hemorrhages can be supplied by both celiac artery and SMA
                                                • Specifically 2nd and 3rd portions of duodenum
                                              • Upper and mid esophagus is supplied by short aortic branches
                                              • Lower esophagus is supplied by left gastric artery
                                            • Epidemiology
                                              • ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
                                                • > 80% have UGI source
                                              • Prior to introduction of endoscopic/endovascular treatments, mortality was 25%
                                              • Since introduction of endoscopic/endovascular treatments, mortality has dropped to 5%
                                            • Causes of UGI hemorrhage
                                              • ~ 70% of UGI hemorrhage are due to gastric or duodenal ulcer disease of erosive gastritis/duodenitis
                                              • Secondary causes of UGI hemorrhage
                                                • ~ 6% Mallory-Weiss tear
                                                • ~ 4% cancer
                                                • ~ 20% other

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Equipment Preparation

                                                    • Procedure Steps

                                                      • Alternative Procedures/Therapies

                                                        POST PROCEDURE

                                                        • Things to Do

                                                          • Things to Avoid

                                                            OUTCOMES

                                                            • Problems

                                                              • Complications

                                                                • Expected Outcome

                                                                  Selected References

                                                                  1. Aquarius M et al: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol. 27(9):1011-6, 2015
                                                                  2. Loffroy R et al: Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 96(7-8):731-44, 2015
                                                                  3. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                                                  4. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
                                                                  5. Huang YS et al: Transcatheter arterial embolization with N-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically unstable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol. 25(12):1850-7, 2014
                                                                  6. Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
                                                                  7. Mejaddam AY et al: Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. J Trauma Acute Care Surg. 75(3):398-403, 2013
                                                                  8. El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
                                                                  9. Angle JF et al: Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21(10):1479-86, 2010
                                                                  10. van Leerdam ME: Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):209-24, 2008
                                                                  11. van Leerdam ME et al: Acute upper GI bleeding: did anything change? time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 98(7):1494-9, 2003