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Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?
Daniel Clerc1, Fabian Grass1, Markus Schäfer1
1Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Insights
Computed tomographic angiography (CTA) offers faster diagnosis for lower gastrointestinal bleeding (LGIB) than lower endoscopy (LE). CTA effectively identifies active bleeding sources, predicting the need for surgery.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Oncology
Background:
- Lower gastrointestinal bleeding (LGIB) diagnosis traditionally relies on lower endoscopy (LE).
- Computed tomographic angiography (CTA) provides a non-invasive, whole-gastrointestinal-tract visualization for immediate diagnosis.
- This study compares the diagnostic value and bleeding control efficacy of LE and CTA in LGIB patients.
Purpose of the Study:
- To compare the diagnostic accuracy of LE and CTA as initial diagnostic modalities for LGIB.
- To evaluate the effectiveness of LE and CTA in achieving bleeding control.
- To assess the utility of CTA in identifying active bleeding and predicting treatment needs.
Main Methods:
- Retrospective analysis of 183 consecutive LGIB patients admitted between 2006 and 2012.
- Comparison of patients undergoing LE versus CTA as their first diagnostic examination.
- Emphasis on diagnostic accuracy, time to diagnosis, and bleeding control outcomes.
Main Results:
- CTA diagnosis was achieved significantly faster than LE (median 3 hours vs. 22 hours).
- Active bleeding was identified more frequently with CTA (31%) compared to LE (15%).
- 80% of patients with active bleeding detected by CTA required surgery, while endoscopic therapy was effective for post-interventional bleeding.
Conclusions:
- LE effectively manages post-interventional LGIB.
- CTA is an efficient and more accessible alternative to colonoscopy for other LGIB causes.
- CTA aids in localizing bleeding sources in active LGIB cases, predicting the necessity for surgical intervention.
Background:
Lower endoscopy (LE) is the standard diagnostic modality for lower gastrointestinal bleeding (LGIB). Conversely, computed tomographic angiography (CTA) offers an immediate non-invasive diagnosis visualizing the entire gastrointestinal tract. The aim of this study was to compare these 2 modalities with regards to diagnostic value and bleeding control.
Methods:
Tertiary center retrospective analysis of consecutive patients admitted for LGIB between 2006 and 2012. Comparison of patients with LE vs. CTA as first exam, respectively, with emphasis on diagnostic accuracy and bleeding control.
Results:
Final analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR = 8.2) vs. 22 (IQR = 36.9) hours, P < 0.001). Active bleeding was identified in 31% with CTA vs. 15% with LE (P = 0.031); a non-actively bleeding source was found by CTA and LE in 22 vs. 31%, respectively (P = 0.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery.
Conclusions:
Post-interventional LGIB was effectively addressed by LE. For other causes of LGIB, CTA was efficient, and more available than colonoscopy. Treatment was conservative for most patients. In case of active bleeding, CTA could localize the bleeding source and predict the need for surgery.
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