Role of computed tomography angiography on the management of overt obscure gastrointestinal bleeding.

Chao-Ming Tseng,Lein-Ray Mo,Chi-Ming Tai,Jaw-Town Lin,I-Chang Lin,Hsiu-Po Wang,Chi-Yang Chang,Chih-Cheng Chen,John Green

doi:10.1371/journal.pone.0172754

Abstract

Background and aimThe 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.MethodsAll 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.ResultsFrom 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.ConclusionsCTA 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.

Highlights

Obscure gastrointestinal bleeding (OGIB), which accounts for 5% of patients presenting with GI hemorrhage, is defined as bleeding from the gastrointestinal (GI) tract that persists or recurs after routine endoscopic studies [1, 2]
The lesions could be identified by the initial route of enteroscopy in more patients with positive Computed tomography angiography (CTA) findings than in those with negative CTA findings (92.0% vs. 47.8%, respectively; P
Between February 2008 and March 2015, a total of 71 patients with acute overt OGIB underwent CTA followed by enteroscopy at E-Da Hospital

Summary

Introduction

Obscure gastrointestinal bleeding (OGIB), which accounts for 5% of patients presenting with GI hemorrhage, is defined as bleeding from the gastrointestinal (GI) tract that persists or recurs after routine endoscopic studies [1, 2]. CTA is reported to be a good diagnostic tool in patients with acute GI bleeding throughout the GI tract [8], studies reporting the role of CTA in the management of overt OGIB are scarce. Others have strongly recommended CTA for the management of overt OGIB in patients with active bleeding, but the level of evidence was low [9]. In order to fill in missing data, we performed this study to evaluate the clinical role of CTA in patients with active overt OGIB. 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

Results

Conclusion