Diagnostic yield of dual‐phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non‐diagnostic capsule endoscopy

Abstract

In patients with a non-diagnostic capsule endoscopy examination, CTE is useful for detecting a source of GI bleeding in patients with overt, but not occult, obscure GI bleeding.

144 Assessment of Multi-Modality Evaluations of Obscure Gastrointestinal Bleeding

“…This is also reflected by the matched odds ratios comparing VCE and MPCTE to DBE where there were no increased odds of finding a bleeding site at DBE compared to VCE and increased odds at DBE compared to MPCTE. In our data, none of the tests had a significantly higher yield in patients with overt bleeding compared to occult bleeding, which is unlike prior studies [23][24][25] In conclusion, our data suggest that DBE is a generally safe and well tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE, which has the benefits of improved diagnostic yield in these patients, ability to intervene therapeutically, and avoidance of an additional diagnostic test.…”

Gastrointestinal hemorrhage: evaluation with MDCT

“…In a meta-analysis of 18 studies, CTE had a pooled yield of 40% compared to 53% for capsule endoscopy [48]. Other studies have shown similar yields for CTE [22,[55][56][57].…”

“…In a study of 30 patients with negative CTE, subsequent capsule endoscopy was positive in 57% [49]. In another study of 52 patients with non-diagnostic capsule endoscopy, subsequent CTE had a 50% positive yield in those patients with overt OGIB [57]. Capsule endoscopy has a higher sensitivity for detecting vascular abnormalities, while CTE is superior for detecting mural-based small bowel masses and is also useful as a screening for contraindications for capsule endoscopy.…”

Unfolding the Plot of Obscure Gastrointestinal Bleeding: Excellent or Elementary?

“…The diagnostic yield of computed tomographic enterography is highest with overt (50%) as compared with occult bleeding (0%) when CE is nondiagnostic. 11 Intravenous angiography is best during active bleeding and therapeutic embolization offered during intervention, although it lacks the sensitivity in differentiating causes such as angiodysplasias vs ulcers. From the outset, it appears that CE and DBE are complementary.…”