Turkiye Klinikleri Journal of Internal Medical Sciences

Gastrointestinal Sistem Radyolojisi Özel Sayısı
Gastrointestinal Kanamalarda Anjiografinin Tanısal Değeri ve Endovasküler Tedavinin Etkinliği
THE ROLE OF ANGIOGRAPHY AND ENDOVASCULAR EMBOLIZATION IN THE TREATMENT OF GASTROINTESTINAL HEMORRHAGE
Fürüzan NUMANa, Murat CANTAŞDEMİRa, Ahmet BAŞa, Aylin HASANEFENDİOĞLUb, Atilla Süleyman DİKİCİa
aRadyoloji AD, Girişimsel Radyoloji BD, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, İSTANBUL bRadyoloji AD, Dicle Üniversitesi Tıp Fakültesi, DİYARBAKIR
Turkiye Klinikleri J Int Med Sci. 2007;3(13):47-52
Article Language: TR
ÖZET
 Gastrointestinal sistem (GİS) kanamaları üst ve alt gastrointestinal sistem kanamaları olmak üzere ikiye ayrılır. Üst GİS kanamaları Treitz ligamanının proksimalinden kaynaklanırken alt GİS kanamaları Treitz ligamanının distalinden kaynaklanır. Üst GİS kanamalarının en sık sebepleri gastrik ülser, gastrit, Mallory-Weiss yırtıkları ve gastroözefageal varislerdir. Mortalite oranı yaklaşık %14'tür. Alt GİS kanamalarının en sık nedenleri ise arteriovenöz malformasyon, anjiodisplazi, divertiküloz, ve endoskopik biyopsidir ve mortalite oranı %5'den azdır. Tüm GİS kanamalı hastalarda ilk yapılması gereken hemodinamik stabilizasyonu sağlamaktır. Daha sonra kanama odağı aranmalıdır. Üst GİS kanamalarının tanı ve tedavisinde altın standart endoskopidir. Alt GİS kanamalarında ise seçilmesi gereken yöntem anjiyografidir. Endoskopinin efektif olamayacağı üst GİS kanamalarının ve alt GİS kanamalarının tedavisinde endovasküler transkateter embolizasyon yöntemi kullanılabilir. Bu amaçla; üst GİS kanamalarında sırası ile selektif çöliak trunkus ve süperior mezenterik, alt GİS kanamalarında ise sırası ile süperior ve inferior mezenterik artreriografiler yapılır. Kanama odağı ve lezyonun natürüne göre embolizan ajanlardan (Gelfoam, otolog pıhtı, polivinil alkol partikülleri, mikrosfer partikülleri, histoakril, bırakılabilir balonlar veya koiller) uygun olanı ile embolizasyon gerçekleştirilir. Bu yazının amacı GİS kanamalı olgularda anjiografinin ve endovasküler transkateter embolizasyonun yerini vurgulamaktır.

Anahtar Kelimeler: Gastrointestinal kanama; embolizasyon
ABSTRACT
 Gastrointestinal system (GIS) hemorrahages could involve upper or lower gastrointestinal tract. In upper gastrointestinal bleeding, the bleeding site is by definition proximal to the ligament of Treitz. A bleeding site distal to the ligament of Treitz is defined as lower gastrointestinal bleeding. The overall mortality rate of upper gastrointestinal bleeding is approximately 14%, and that of lower gastrointestinal bleeding lower than 5%. Most of the reasons of upper GIS hemorrhages are gastric ulcer, gastritis, Mallory-Weiss syndrome and gastroosephageal varicoses. However, most of the reasons of lower GIS hemorrhages are arteriovenous malformation, anjiodysplasia, diverticulosis and endoscopic biopsies. At fırst, hemodynamic stabilization should be achieved in all patients. While searching the site of the hemorrhage, endoscopy is the gold standart for upper and angiography is the gold standart for lower GIS hemorrhages. Endovascular transcathater embolization can be applied in patients of ineffective endoscopic maneuvers who have upper GIS hemorrhages and in the treatment of lower GIS hemorrhages. If the bleeding appeared to be in the upper gastrointestinal tract, the celiac and superior mesenteric arteries were catheterized initially; and if bleeding appeared to be in the lower gastrointestinal tract, the superior and inferior mesenteric arteries were catheterized first. Embolizing agents (gelfoam, otologous clot, polyvynil alcohol particles, microspheres, histoacryl, detachable balloon, micro and macrocoils) are used regarding to the bleeding side and the nature of the lesion. Purpose of this study is the evolution of the role of angiography and endovascular transcathater embolization in the treatment of GIS hemorrahages.

Keywords: Gastrointestinal hemorrhage; embolization, therapeutic

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