Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan.

Abstract

To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding. An IRB-approved retrospective study was conducted of 35 consecutive patients diagnosed with GI bleeding that received angiography for planned catheter-directed embolization. Of these patients, 20 were diagnosed with bleeding using a tagged RBC scan, whereas 15 were diagnosed using CTA. The lengths of time between diagnostic study order to study completion, diagnostic study completion to angiography, and total time from diagnostic study order to angiography were calculated. The results of both groups were compared using a t test with p value of < 0.05 considered statistically significant. The mean time from diagnostic study order to study completion was 3h and 4min for the CTA group and 5h and 1min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to intervention was 6h and 8min for the CTA group and 9h and 29min for the tagged RBC scan group, a statistically significant difference (p value = 0.028). In patients requiring conventional angiography for GI bleeding, CT angiography results in a faster time to angiography than tagged RBC scan, which appears to be due to the longer duration required to complete the tagged RBC scan. Decreasing time to angiography is vital, as GI bleeding can be fatal and earlier diagnosis and intervention has the potential to reduce morbidity and mortality, while also increasing sensitivity of angiography. These findings may assist ordering clinicians in deciding on the appropriate diagnostic study.