Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit.

Publisher: Springer Country of Publication: United States NLM ID: 101674571 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2366-0058 (Electronic) NLM ISO Abbreviation: Abdom Radiol (NY) Subsets: MEDLINE

Original Publication: [New York] : Springer, [2016]-

Gastrointestinal Hemorrhage*/diagnostic imaging ; Multidetector Computed Tomography*/methods ; Computed Tomography Angiography*/methods; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Adult ; Aged, 80 and over ; Sensitivity and Specificity

Background: Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking.
Aim: The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding.
Methods: Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3 h) or following (< 3 h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards.
Results: A total of 68 patients (38 men, median age 69 years [range 25-96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5-87.3), 40% (95% CI: 5.3-85.3), and 75% (95% CI: 63.0-84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2-97.5) and 79% (95% CI: 66.8-88.3), respectively.
Conclusion: Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Laine L, Yang H, Chang S-C, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol 2012; 107: 1190–1195;. (PMID: 10.1038/ajg.2012.16822688850)
Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci 2018; 63: 1286–1293. (PMID: 10.1007/s10620-017-4882-629282637)
Ew L, Jm L. Differential diagnosis of gastrointestinal bleeding. Techniques in vascular and interventional radiology 2004; 7. (PMID: 10.1053/j.tvir.2004.12.001)
4 Hearnshaw SA, Logan RFA, Lowe D, Travis SPL, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327–1335. (PMID: 10.1136/gut.2010.22843721490373)
Sanders DS, Perry MJ, Jones SGW, McFarlane E, Johnson AG, Gleeson DC, Lobo AJ. Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. Eur J Gastroenterol Hepatol 2004; 16: 487–494. (PMID: 10.1097/00042737-200405000-0000915097042)
van Leerdam ME, Vreeburg EM, Rauws E a. J, Geraedts A a. M, Tijssen JGP, Reitsma JB, Tytgat GNJ. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494–1499. (PMID: 10.1111/j.1572-0241.2003.07517.x12873568)
Nahon S, Hagège H, Latrive JP, Rosa I, Nalet B, Bour B, Faroux R, Gower P, Arpurt JP, Denis J, Henrion J, Rémy AJ, Pariente A, Groupe des Hémorragies Digestives Hautes de l’ANGH. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study. Endoscopy 2012; 44: 998–1008.
Jairath V, Kahan BC, Logan RF, Hearnshaw SA, Dore CJ, Travis SP, Murphy MF, Palmer KR. National audit of the use of surgery and radiological embolization after failed endoscopic haemostasis for non-variceal upper gastrointestinal bleeding. Br J Surg 2012; 99: 1672-1680. (PMID: 10.1002/bjs.893223023268)
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol 2021; 116: 899–917. (PMID: 10.14309/ajg.000000000000124533929377)
Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, Laursen SB, Radaelli F, Papanikolaou IS, Cúrdia Gonçalves T, Dinis-Ribeiro M, Awadie H, Braun G, de Groot N, Udd M, Sanchez-Yague A, Neeman Z, van Hooft JE. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy 2021; 53: 300–332. (PMID: 10.1055/a-1369-527433567467)
Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, Jung HY, Sollano JD, Gotoda T, Reddy N, Singh R, Sugano K, Wu KC, Wu CY, Bjorkman DJ, Jensen DM, Kuipers EJ, Lanas A. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut 2018; 67:1757-1768. (PMID: 10.1136/gutjnl-2018-31627629691276)
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med 2019; 171: 805-822. (PMID: 10.7326/M19-1795316349177233308)
Lieberman D. Gastrointestinal bleeding: initial management. Gastroenterol Clin North Am 1993; 22: 723–736. (PMID: 10.1016/S0889-8553(21)00103-57905862)
Vreeburg EM, Snel P, de Bruijne JW, Bartelsman JF, Rauws EA, Tytgat GN. Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome. Am J Gastroenterol 1997; 92: 236–243. (PMID: 9040198)
Napoli A, Fleischmann D, Chan FP, Catalano C, Hellinger JC, Passariello R, Rubin GD. Computed tomography angiography: state-of-the-art imaging using multidetector-row technology. J Comput Assist Tomogr 2004; 28 Suppl 1: S32-45. (PMID: 10.1097/01.rct.0000120859.80935.1015258492)
Wu L-M, Xu J-R, Yin Y, Qu X-H. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol 2010; 16: 3957–3963. (PMID: 10.3748/wjg.v16.i31.3957207120582923771)
Di Serafino M, Iacobellis F, Schillirò ML, Dell’Aversano Orabona G, Martino A, Bennato R, Borzelli A, Oliva G, D’Errico C, Pezzullo F, Barbuto L, Ronza R, Ponticiello G, Corvino F, Giurazza F, Lombardi G, Niola R, Romano L. The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings. Tomography 2022; 8: 2369-2402. (PMID: 10.3390/tomography8050198362877979606936)
Martino A, Di Serafino M, Amitrano L, Orsini L, Pietrini L, Martino R, Menchise A, Pignata L, Romano L, Lombardi G. Role of multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: A comprehensive review. World J Gastrointest Endosc 2022; 14: 739-747. (PMID: 10.4253/wjge.v14.i12.739365678239782566)
Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 2003; 228: 743–752. (PMID: 10.1148/radiol.228302075612954894)
Triantafyllou K, Gkolfakis P, Gralnek IM, Oakland K, Manes G, Radaelli F, Awadie H, Camus Duboc M, Christodoulou D, Fedorov E, Guy RJ, Hollenbach M, Ibrahim M, Neeman Z, Regge D, Rodriguez de Santiago E, Tham TC, Thelin-Schmidt P, van Hooft JE. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 850–868. DOI: https://doi.org/10.1055/a-1496-8969.
Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol 2016; 111: 459–474. (PMID: 10.1038/ajg.2016.41269258835099081)
Oakland K, Chadwick G, East JE, Guy R, Humphries A, Jairath V, McPherson S, Metzner M, Morris AJ, Murphy MF, Tham T, Uberoi R, Veitch AM, Wheeler J, Regan C, Hoare J. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut 2019; 68: 776-789. (PMID: 10.1136/gutjnl-2018-31780730792244)
British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002; 51: iv1-iv6 DOI: https://doi.org/10.1136/gut.51.suppl_4.iv1.
Yoon W, Jeong YY, Kim JK. Acute gastrointestinal bleeding: contrast-enhanced MDCT. Abdom Imaging 2006; 31: 1-8. (PMID: 10.1007/s00261-005-0367-816333701)
Yoon W et al (2006) Acute massive gastrointestinal bleeding: detection and localization with arterial phase multidetector row helical CT. Radiology 239:160–167. (PMID: 10.1148/radiol.238305017516484350)
Willmann JK, Roos JE, Platz A et al (2002) Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol 179:437–444. (PMID: 10.2214/ajr.179.2.179043712130447)
Kim D, Kim JH, Ko DR, Min IK, Choi A, Beom JH. Usefulness of contrast-enhanced multi-detector computed tomography in identifying upper gastrointestinal bleeding: A retrospective study of patients admitted to the emergency department. PLoS One 2022; 17: e0266622. (PMID: 10.1371/journal.pone.0266622353900828989213)
Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, Kim JK, Kang HK. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 2006; 239: 160–167. (PMID: 10.1148/radiol.238305017516484350)
Scheffel H, Pfammatter T, Wildi S, Bauerfeind P, Marincek B, Alkadhi H. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT. Eur Radiol 2007; 17: 1555–1565. (PMID: 10.1007/s00330-006-0514-917171511)
Jaeckle T, Stuber G, Hoffmann MHK, Jeltsch M, Schmitz BL, Aschoff AJ. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT. Eur Radiol 2008; 18: 1406–1413. (PMID: 10.1007/s00330-008-0907-z18351347)
Fung HS, Kwok PC, Lau S, Wong WK, Chan SCH. 64-slice multi-detector computed tomography for detection of acute gastrointestinal bleeding. J HK Coll Radiol 2008; 11: 13–18.
Frattaroli FM, Casciani E, Spoletini D, Polettini E, Nunziale A, Bertini L, Vestri A, Gualdi G, Pappalardo G. Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding. World J Surg 2009; 33: 2209–2217. (PMID: 10.1007/s00268-009-0156-619653032)
Sun H, Jin Z, Li X, Qian J, Yu J, Zhu F, Zhu H. Detection and localization of active gastrointestinal bleeding with multidetector row computed tomography angiography: a 5-year prospective study in one medical center. J Clin Gastroenterol 2012; 46: 31–41. [PMID: 22064550 DOI: https://doi.org/10.1097/MCG.0b013e31823337ee ]. (PMID: 10.1097/MCG.0b013e31823337ee22064550)
Miyaoka Y, Amano Y, Ueno S, Izumi D, Mikami H, Yazaki T, Okimoto E, Sonoyama T, Ito S, Fujishiro H, Kohge N, Imaoka T. Role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding. J Gastroenterol Hepatol 2014; 29: 716–722. [PMID: 24224950 DOI: https://doi.org/10.1111/jgh.12447 ]. (PMID: 10.1111/jgh.1244724224950)
Miller FH, Hwang CM. An initial experience: using helical CT imaging to detect obscure gastrointestinal bleeding. Clin Imaging 2004; 28: 245-251. (PMID: 10.1016/S0899-7071(03)00193-115246473)
Sos TA, Lee JG, Wixson D, Sniderman KW. Intermittent bleeding from minute to minute in acute massive gastrointestinal hemorrhage: arteriographic demonstration. AJR Am J Roentgenol 1978; 131: 1015-1017. (PMID: 10.2214/ajr.131.6.1015104564)
Lim CM, Shridhar I, Tan L, Cheah WK. Contrast CT in localization of acute lower gastrointestinal bleeding. Asian J Surg 2006; 29: 92-94. (PMID: 10.1016/S1015-9584(09)60114-716644509)

Keywords: Computed tomography angiography; Endoscopy; Non-variceal upper gastrointestinal bleeding

Date Created: 20240304 Date Completed: 20240521 Latest Revision: 20240624

20240624

10.1007/s00261-024-04208-9

38436701