What is the role of angiography in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Angiography may be useful if bleeding persists and endoscopy fails to identify a bleeding site. According to the 2010 American College of Radiology (ACR) guidelines, angiography along with transcatheter arterial embolization (TAE) should be considered for all patients with a known source of arterial upper gastrointestinal (GI) bleeding (UGIB) that does not respond to endoscopic management, or in patients with active bleeding and a negative endoscopy. [61]

In clinically unstable patients, angiography should be considered the preferred diagnostic and therapeutic strategy after failed endoscopy, as it has favorable clinical outcomes compared with emergent surgery for UGIB. [63, 64]

There are highly variable sensitivity and specificity for catheter angiography in the literature, with sensitivity averaging 60%, [63] as well as a 60%-100% technical success rate for UGIB (73%-100% for lower GI bleeding). [39] Angiography not only has a high spatial resolution and can detect rates of bleeding as low as 0.5 mL/min, [65]  but it also has the added major advantage of allowing for treatment of GI bleeding with embolization therapy. However, its primary disadvantage is that it is an invasive and time-consuming procedure with a potentially high radiation dose. In addition, patients may have falsely negative findings in the presence of intermittent GI bleeding and if there is no active bleeding during the angiogram. [62]

In cases of aortoenteric fistula, angiography requires active bleeding (1 mL/min) to be diagnostic.


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