Therapeutic options for endoscopic haemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding

The management of gastrointestinal tract bleeding has changed dramatically due to improvements of interventional endoscopy and radiology. The place of the radiologist has become very important, not only for diagnostic modalities but also for therapeutic embolisation to control the bleeding. The place of the surgeon is limited to the situation where both these less invasive techniques have failed to stop the bleeding. For arterial bleeding in the whole GI tract, angiography with subsequent embolisation is performed after failed endoscopy. For variceal bleeding the preferred treatment after endoscopic failure is transjugular intrahepatic porto-systemic stent shunting (TIPS). Surgery is only needed in exceptional cases. Embolisation can be performed successfully without compromising the bowel vascularisation or inducing ischaemia, whereas surgery has a high rate of complications and mortality. For treatment of GI bleeding a multidisciplinary team including a gastroenterologist, radiologist and surgeon is mandatory.