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Upper Gastrointestinal Hemorrhage
Andrew Kolarich, MD; Yvonne Tsitsiou; Christos Georgiades, MD, PhD, FSIR, FCIRSE
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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 GI 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 midesophagus are supplied by short aortic branches
              • Lower esophagus is supplied by left gastric artery; branch of celiac 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%; it is now ~ 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
                • Mallory-Weiss tear: ~ 6%
                • Cancer: ~ 4%
                • Other: ~ 20%

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Equipment Preparation

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Expected Outcome

                          • Things to Do

                            • Things to Avoid

                              OUTCOMES

                              • Problems

                                • Complications

                                  • Expected Outcome

                                    Selected References

                                    1. Dariushnia SR et al: Society of Interventional Radiology quality improvement standards for percutaneous transcatheter embolization. J Vasc Interv Radiol. 32(3):476.e1-33, 2021
                                    2. Mujtaba S et al: Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med. 9(2), 2020
                                    3. Vora P et al: Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 3(10):e2020172, 2020
                                    4. Warhadapande S et al: Clinical approach to and work-up of bleeding patients. Semin Intervent Radiol. 37(1):24-30, 2020
                                    5. Foltz G et al: Embolization of nonvariceal upper gastrointestinal hemorrhage complicated by bowel ischemia. Semin Intervent Radiol. 36(2):76-83, 2019
                                    6. 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
                                    7. 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
                                    8. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                    9. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
                                    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 GI 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 midesophagus are supplied by short aortic branches
                                                • Lower esophagus is supplied by left gastric artery; branch of celiac 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%; it is now ~ 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
                                                  • Mallory-Weiss tear: ~ 6%
                                                  • Cancer: ~ 4%
                                                  • Other: ~ 20%

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Preprocedure Imaging

                                                  • Getting Started

                                                    PROCEDURE

                                                    • Equipment Preparation

                                                      • Procedure Steps

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Expected Outcome

                                                            • Things to Do

                                                              • Things to Avoid

                                                                OUTCOMES

                                                                • Problems

                                                                  • Complications

                                                                    • Expected Outcome

                                                                      Selected References

                                                                      1. Dariushnia SR et al: Society of Interventional Radiology quality improvement standards for percutaneous transcatheter embolization. J Vasc Interv Radiol. 32(3):476.e1-33, 2021
                                                                      2. Mujtaba S et al: Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med. 9(2), 2020
                                                                      3. Vora P et al: Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 3(10):e2020172, 2020
                                                                      4. Warhadapande S et al: Clinical approach to and work-up of bleeding patients. Semin Intervent Radiol. 37(1):24-30, 2020
                                                                      5. Foltz G et al: Embolization of nonvariceal upper gastrointestinal hemorrhage complicated by bowel ischemia. Semin Intervent Radiol. 36(2):76-83, 2019
                                                                      6. 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
                                                                      7. 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
                                                                      8. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                                                      9. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014