Selection of Non-Operative Hemostatic Therapeutic Strategies for Lower Gastrointestinal Bleeding

Abstract

Non-operative hemostatic therapeutic strategies for lower gastrointestinal bleeding have been less-reported than in the case of upper gastrointestinal bleeding and have not yet been established. To evaluate non-operative hemostatic therapeutic strategies for lower gastrointestinal bleeding, 11 patients without iatrogenic bleeding from a total of 37 patients with lower gastrointestinal bleeding were reviewed for medication and results. Bleeding points were the ileum in 1 the ascending colon in 3, the transverse colon in 1, the descending colon in 2, and the rectum in 4 patients. Five patients had colonic diverticula, 2 had a rectal ulcer, and 1 each had ulcerative colitis, angiodysplasia, bleeding at the anastomosis, and metastasis from lung cancer. Interventional radiology (IVR) with arterial embolization using microcoils was performed for 2 patients. IVR for 1 patient with ileal metastasis from lung cancer succeeded, but IVR for i patient with colonic diverticula started bleeding again and colonoscopy with clipping was performed to stop the bleeding. Endoscopic hemostasis was achieved with clipping in 7 patients using, and argon plasma coagulation and radiofrequency coagulation in 1 patient each. Among non-operative hemostatic therapeutic strategies for lower gastrointestinal bleeding, the first choice for small intestinal hemorrhage was IVR, and the first choice for colonic hemorrhage was endoscopy.