Role of computed tomography angiography on the management of overt obscure gastrointestinal bleeding
Journal
PLoS ONE
Journal Volume
12
Journal Issue
3
Date Issued
2017
Author(s)
Abstract
Background and aim: The role of computed tomography angiography (CTA) on the management of acute overt obscure gastrointestinal bleeding (OGIB) remains unclear. We designed a study to evaluate the impact of CTA before enteroscopy for acute overt OGIB. Methods: All patients undergoing CTA followed by enteroscopy for acute overt OGIB were enrolled in this retrospective study. Clinical characteristics and diagnosis were compared between patients with positive and negative CTA findings. We evaluated the impact of CTA on subsequent enteroscopy. Results: From February 2008 to March 2015, 71 patients including 25 patients with positive CTA findings and 46 patients with negative CTA findings, were enrolled. All 25 patients with positive CTA findings were confirmed to have mid GI lesions, a significantly higher proportion than among patients with negative CTA findings (100% vs. 52.2%, respectively; P <0.001). CTA had a higher diagnostic yield for bleeding from tumor origin than from non-tumor origin (80.0% vs. 23.7%, respectively; P <0.001). The diagnostic yield of CTA and enteroscopy was 35.2% and 73.2%, respectively. The lesions could be identified by the initial route of enteroscopy in more patients with positive CTA findings than in those with negative CTA findings (92.0% vs. 47.8%, respectively; P <0.001). Lesions could be identified in seven of the 25 patients (28.0%) with positive CTA findings by using only push enteroscopy instead of single-balloon enteroscopy (SBE), but all 46 patients with negative CTA findings needed SBE for deep small-bowel examination. Conclusions: CTA is useful in the diagnosis of acute overt OGIB, especially in patients with bleeding from tumors. In addition, it also can show the precise location of bleeding, and guide subsequent enteroscopic management. ? 2017 Tseng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
acute disease; adult; Article; case management; clinical feature; computed tomographic angiography; computed tomography scanner; controlled study; diagnostic test accuracy study; diagnostic value; digestive system injury; female; gastrointestinal hemorrhage; gastrointestinal tumor; human; intestine endoscopy; major clinical study; male; middle aged; overt obscure gastrointestinal bleeding; push enteroscopy; rectum hemorrhage; retrospective study; single balloon enteroscopy; aged; angiography; diagnostic imaging; evaluation study; gastrointestinal hemorrhage; procedures; x-ray computed tomography; Aged; Angiography; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Tomography, X-Ray Computed
Publisher
Public Library of Science
Type
journal article