Radiologic Interventions for Gastrointestinal Bleeding.

Abstract

Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency for which endoscopy remains the primary diagnostic and therapeutic modality. However, a subset of patients experiences persistent or recurrent bleeding, that requires stabilization before endoscopy or presents with lesions, that are inaccessible or unsuitable for endoscopic treatment. This review outlines the role of radiological intervention in these clinical settings. This article reviews the use of computed tomography angiography as the principal preprocedural imaging modality, focusing on its ability to localize active bleeding, characterize the underlying etiologies, and delineate the vascular anatomy relevant to catheter-based interventions. The indications, techniques, and outcomes of transcatheter arterial embolization for non-variceal GI bleeding are also summarized, including the application of superselective catheterization and commonly used embolic materials. This review describes the hemodynamically targeted interventional approaches for variceal GI bleeding associated with portal hypertension. The technical principles and clinical roles of the transjugular intrahepatic portosystemic shunt (TIPS) for portal decompression and balloon-occluded retrograde transvenous obliteration (BRTO) and its variants for gastric varices are discussed. Percutaneous variceal embolization has also been reviewed as an adjunctive option in selected situations in which endoscopic therapy, TIPS, or BRTO is not feasible or unsuccessful. Overall, this review summarizes the current imaging strategies and interventional techniques for GI bleeding, emphasizing patient selection based on bleeding etiology, vascular and portal venous anatomy, and hemodynamic status.