Angiography in the diagnosis of ulcerative gastroduodenal bleeding

Acute Gastrointestinal Bleeding (AGIB) of Ulcerative Origin poses a life-threatening risk and requires a clear diagnostic and therapeutic strategy. If endoscopic hemostasis and conservative therapy are ineffective, an essential method is angiography of the stomach and duodenal vessels to identify the bleeding source and perform endovascular hemostasis. Aim: to study the angiographic semiotics of AGIB of ulcerative origin to improve the efficiency of diagnosis and treatment; to assess the capabilities of superselective arteriography in determining the bleeding source and its impact on the choice of endovascular hemostasis tactics. Materials and methods. The results of angiographic examination of the stomach and duodenal vessels in 17 patients with gastroduodenal ulcers complicated by AGIB were analyzed. All patients had a high surgical risk amid active bleeding. The examined parameters included direct angiographic signs and indirect signs. Results. In 14 (82.4%) patients, who underwent angiography during active bleeding, the bleeding source was directly identified based on contrast extravasation, pseudoaneurysm, or intense contrast accumulation at the ulcer site. In 3 (17.4%) patients, only indirect signs (arterial spasm, hypervascularization, arteriovenous shunting) were noted. Conclusions. The study of angiographic patterns of AGIB sources in patients with ulcer disease showed that superselective arteriograms were the most informative. Performing superselective arteriography with the identification of direct and indirect angiographic signs of bleeding allowed precise localization of the source in the celiac trunk or superior mesenteric artery, followed by appropriate endovascular hemostasis based on the angiographic findings. The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the local ethics committee of the institutions mentioned in the study. Informed consent was obtained from all participants. The authors declare no conflict of interest.