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Endoscopy with provocation effective for identifying refractory GI bleeding source
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Endoscopy combined with pharmacologic provocation of bleeding with antiplatelet and/or anticoagulant agents is a safe and effective option for identifying the source of refractory GI bleeding, according to Louisiana State University researchers.
“This is the first case series to evaluate the benefit and safety of provocative testing combined with endoscopy to be reported in the literature,” Daniel Raines, MD, chief of the section of gastroenterology at LSU Health New Orleans School of Medicine, said in a press release.
Raines and colleagues retrospectively evaluated 824 device-assisted enteroscopy procedures performed from October 2007 through October 2015, and identified 38 cases (27 patients) in which provocation was used to evaluate GI bleeding. Overall, 13 of these cases were in patients with a history of antiplatelet/anticoagulant-associated bleeding, 18 were in patients naive to antiplatelets/anticoagulants, and seven were in patients with recurrent, overt GI bleeding who were evaluated using LSU protocol, involving endoscopy in combination with clopidogrel and IV heparin.
The researchers found that provocative testing had a 53% diagnostic yield in the provocation-experienced cases, 27% in the provocation-naive cases and 71% in the cases evaluated using LSU protocol. Overall, provocative testing was successful in 15 of the 27 patients (56%), with the most common pathologies being angioectasia and Dieulafoy lesions. Four patients saw no benefit from provocative testing, and the source of bleeding was eventually identified as intestinal angioectasia in three of them and an aorto-enteric fistula in one.
Moreover, no adverse events occurred.
“The decision to attempt provocation of bleeding in patients with an unknown bleeding source should not be taken lightly, particularly when the provocative agent is not otherwise indicated,” Raines said in the press release. “Our study demonstrates that provocative endoscopy can be performed safely and successfully, and it may be a justifiable intervention in highly selected cases where death associated with recurrent bleeding justifies the risk.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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