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Long-term outcomes of obscure gastrointestinal bleeding after CT enterography: does negative CT enterography predict
Jae Kook Shin1, Jae Hee Cheon, Joon Seok Lim
1Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Insights
Computed tomography enterography (CTE) effectively detects obscure gastrointestinal bleeding (OGIB). However, negative CTE results do not guarantee lower rebleeding rates, necessitating close patient observation and prompt management for positive findings.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Computed tomography enterography (CTE) shows promise for small bowel imaging.
- The diagnostic and prognostic role of CTE in obscure gastrointestinal bleeding (OGIB) remains unclear.
Purpose of the Study:
- To evaluate the diagnostic efficacy of CTE in OGIB.
- To assess long-term outcomes, particularly rebleeding rates, based on CTE findings in OGIB patients.
Main Methods:
- A cohort of 63 consecutive patients with OGIB undergoing CTE was analyzed.
- Clinical data pre- and post-CTE were collected, distinguishing between specific (hemostasis, surgery) and non-specific (anemia management) treatments.
Main Results:
- Positive lesions were identified in 26.7% of patients with available follow-up data.
- The overall rebleeding rate was 21.7% over a mean follow-up of 17.6 months.
- No significant difference in rebleeding rates was observed between positive and negative CTE groups (P=0.241); however, specific treatments in positive CTE patients significantly reduced rebleeding (P=0.023).
Conclusions:
- CTE demonstrates high detection rates for overt OGIB.
- Negative CTE results do not predict reduced long-term rebleeding, indicating a need for continued surveillance.
- Aggressive management in patients with positive CTE findings significantly lowers rebleeding incidence.
Background And Aim:
Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long-term outcomes based on CTE findings, with special reference to negative CTE.
Methods:
A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre- and post-CTE clinical data were collected. "Specific treatments" were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while "non-specific treatments" were defined as symptomatic treatments for anemia.
Results:
Among 60 patients for whom long-term follow-up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023).
Conclusions:
CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long-term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.
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