Multidetector computed tomography in acute lower gastrointestinal bleeding

Milot, Laurent; Palma, John F.; Mihaila, Marius; Monneuse, Olivier; Pilleul, F.

doi:10.2147/rmi.s13250

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…CT has also been shown to localize accurately the site of bleeding ( 165 ). Other studies have shown sensitivities of 79-94% and specifi city of 95-100% for detecting active bleeding throughout the GI tract (165)(166)(167). In a study of 113 consecutive patients with active GI bleeding, CTA was positive in 80/113 (70.8%), all of which were confi rmed.…”

Section: Ct Angiographymentioning

confidence: 89%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

583

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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Section: Ct Angiographymentioning

confidence: 89%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

583

559

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“…MDCT for the evaluation of acute UGIB is rarely described. In one study with 34 patients, extravasation of the contrast agent was found in 30 patients (88%) with lower GIB, which correlated to the site of bleed by subsequent endoscopy or surgical evaluation [104]. CT of the abdomen without and with contrast is a diagnostic examination to be considered in patients who are suspected to have hemobilia [89].…”

Section: Variant and Procedures Informationmentioning

confidence: 99%

ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding

Singh-Bhinder

Kim

Holly

et al. 2017

Journal of the American College of Radiology

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Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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“…It is known that a high injection rate (4-5 mL/s) is important for the acquisition of the arterial phase ( 55 ) , and most studies in the literature approaching GIB evaluation utilized injection rate ≥ 4 mL/s ( 5 , 14 , 25 , 26 , 30 - 35 , 38 , 39 ) .…”

Section: Variables Involved In the Preparation And Performance Of Ct mentioning

confidence: 99%

“…The use of CT angiography in cases of suspicion of GIB has been implemented with a wide variability of protocols ( Table 1 ), but a protocol comprising three acquisition phases (non-contrast-enhanced, arterial and portal phases) has most frequently been adopted ( 14 , 25 , 26 , 28 , 29 , 31 , 34 , 35 , 37 , 39 , 40 ) .…”

Section: Variables Involved In the Preparation And Performance Of Ct mentioning

confidence: 99%

Computed tomography angiography in patients with active gastrointestinal bleeding

Reis

Cardia²,

D'Ippólito

2015

Radiol Bras

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Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

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Multidetector computed tomography in acute lower gastrointestinal bleeding

Cited by 9 publications

References 34 publications

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding

Computed tomography angiography in patients with active gastrointestinal bleeding

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