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Outcome following a negative CT Angiogram for gastrointestinal hemorrhage
Victoria Chan1, Donald Tse, Shaheen Dixon
1Department of Radiology, Level 2, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK, drvictoriac@gmail.com.
Insights
A negative computed tomography angiogram (CTA) for gastrointestinal (GI) bleeding is more predictive in lower GI bleeds. Patients with lower GI hemorrhage and negative CTAs are less likely to rebleed than those with upper GI bleeds.
Area of Science:
- Radiology
- Gastroenterology
- Interventional Radiology
Background:
- Gastrointestinal (GI) hemorrhage is a common clinical problem.
- Computed tomography angiography (CTA) is frequently used to diagnose the source of GI bleeding.
- The diagnostic and prognostic value of a negative CTA in GI hemorrhage requires further evaluation.
Purpose of the Study:
- To evaluate the role and predictive value of a negative computed tomography angiogram (CTA) in patients presenting with acute gastrointestinal (GI) hemorrhage.
- To compare the outcomes of patients with upper versus lower GI bleeding following a negative CTA.
Main Methods:
- Retrospective review of 202 CTAs performed for GI hemorrhage in 180 patients over an 8-year period (2005-2012).
- Data collected included patient demographics, hemorrhage location, hemodynamic stability, and angiogram/embolization details.
- Outcomes assessed included rebleeding rates and need for further intervention.
Main Results:
- Of 202 CTAs, 87 were for upper GI hemorrhage (18 positive, 69 negative) and 115 for lower GI hemorrhage (37 positive, 78 negative).
- Patients with lower GI hemorrhage and negative CTAs had a significantly lower rebleeding rate (77.4%) compared to those with upper GI hemorrhage (58.7%) (p=0.04).
- The relative risk of rebleeding after a negative CTA was lower for lower GI bleeding (0.55).
Conclusions:
- A negative CTA is a strong indicator that further intervention may not be immediately required for lower GI hemorrhage.
- Patients with upper GI bleeding and a negative CTA are more likely to require additional interventions to control hemorrhage.
- Negative CTAs have differential prognostic value depending on the location of GI bleeding.
Objective:
This study was designed to evaluate the role of a negative computed tomography angiogram (CTA) in patients who present with gastrointestinal (GI) hemorrhage.
Methods:
A review of all patients who had CTAs for GI hemorrhage over an 8-year period from January 2005 to December 2012 was performed. Data for patient demographics, location of hemorrhage, hemodynamic stability, and details of angiograms and/or the embolization procedure were obtained from the CRIS/PACS database, interventional radiology database, secure electronic medical records, and patient's clinical notes.
Results:
A total of 180 patients had 202 CTAs during the 8-year period: 87 CTAs were performed for upper GI hemorrhage (18 positive for active bleeding, 69 negative) and 115 for lower GI hemorrhage (37 positive for active bleeding, 78 negative); 58.7 % (37/63) of patients with upper GI bleed and 77.4 % (48/62) of patients with lower GI bleed who had an initial negative CTA did not rebleed without the need for radiological or surgical intervention. This difference was statistically significant (p = 0.04). The relative risk of rebleeding, following a negative CTA, in lower GI bleeding versus upper GI bleeding patients is 0.55 (95 % confidence interval 0.32-0.95).
Conclusions:
Patients with upper GI bleed who had negative CTAs usually require further intervention to stop the bleeding. In contrast, most patients presenting with lower GI hemorrhage who had a negative first CTA were less likely to rebleed.
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