title: Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report.
abstract: OBJECTIVE
  To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB).
  
  
  METHODS
  Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3-5 units/h) for 3h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported.
  
  
  RESULTS
  Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%.
  
  
  CONCLUSIONS
  Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan. Electronic address: hlliang@vghks.gov.tw.
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Chiang
authors.affiliation: Department of Radiology, Yuan's General Hospital, Kaohsiung. Taiwan.
authors.forename: Matt Chiung-Yu
authors.initials: MC
authors.lastname: Chen
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yih-Huie
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan.
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002404:Catheterization; D003287:Contrast Media; D023381:Endpoint Determination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects*; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D014667:Vasopressins; D004837:Epinephrine
keywords: Embolization; Intervention; Lower gastrointestinal bleeding; Vasospasm