The Clinical Application Of Digital Subtraction Angiography In Difficult Gastrointestinal Hemorrhage

PurposeTo investigate the clinical application of the digital subtraction angiography in difficult gastrointestinal hemorrhage. To compare the similarity of DSA and CTA for the diagnosis of gastrointestinal bleeding in brief. MethodsThis is a retrospective review of 39 patients who underwent DSA examination for difficult gastrointestinal hemorrhage between December 1998 and March 2007.All patients were performed in a Siemens angiographic suite with either proper embolic agents or Pituitrin. According to the interval from bleeding onset to angiographic time, 39 patients were divided into two groups, the emergency group(25)and the non-emergency group(14). The patients who were performed interventional therapy were separated into the embolic group and perfusion group. Observe the therapeutic effect(including complete hemostasis, partial hemostasis, recurrence and relapse) with three-month follow-up. Chi-Square test is applied between groups with test level of 0.05. ResultsThe skill achievement ratio of this research is up to 100%. There were 30 patients identified the position and reason of the bleeding by the DSA with a total positive rate of angiography of 76.9%(30/39), 88.0%(22/25) in emergency group and 57.1%(8/14) in non-emergency group. There is significantly difference in statistics, that is, the emergency group has a higher positive rate of angiography than non-emergency group. Of the 13 positive angiography patientsthat followed up, there is a great coincidence in position with operation, 10 of which the pathological changes agree with post-operative pathology with coincidence rate of 76.9%(10/13). 3 patients were performed CTA examination before DSA examination. No abnormality was seen in 1, abnormal finding appeared in 2. 27 cases were performed interventional therapy including embolization and perfusion of Pituitrin with a total effective rate of 88.9%(24/27). In these cases the efficiency of bleeding-arrest reached 93.8%(15/16) in embolization group with immediate hemostatic rate of 93.8%(15/16),and 81.8%(9/11) in perfusion of Pituitrin with immediate hemostatic rate of 63.6%(7/11). There is no significant difference between the two groups.Conclusion1. DSA examination overcomes the limitations of routine Barium Enema, fiber endoscope and Radionuclide Scanning, and has apparent superiority in active gastrointestinal hemorrhage stage and small intestinal bleeding.2. The direct angiographic findings can localize accurately, and has no specificity for the etiological diagnosis. While the indirect findings has more values for the diagnosis of etiology.3. DSA examination is regarded as a supplementary for routine methods, results of which can reduce the blindness of DSA.4. Interventional treatment as a definitely therapy for the control gastrointestinal bleeding were preformed after identifying the position and reason for hemorrhage.5. Embolization is the first choice for treatment of UGIH, and should beprudent for LGIH.6. Further investigation is expected whether noninvasive CTA examination can be an efficient way of evaluating gastrointestinal bleeding.