Angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding

The value of angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding is discussed. Based on experience with diagnostic angiography in over 350 acute gastrointestinal bleeders and therapeutic interventional angiography in more than 150 of them several principles are illuminated. Angiography should be used after emergency endoscopy and a trial of medical therapy. Selective vasoconstrictive therapy is highly effective in controlling bleeding superficial mucosal lesions although less effective for bleeding from major arteries as is seen in peptic ulcers. Selective transcatheter occlusive therapy is a fast and effective method for controlling arterial bleeding in appropriate cases. For variceal bleeding low dose intravenous infusion of vasopressin is as effective in decreasing portal pressure and blood flow as is selective superior mesenteric infusion. Direct selective occlusion of gastroesophageal varices by the transhepatic approach is a new and exciting method of treatment for variceal bleeding.