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ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update.
, Karunakaravel Karuppasamy1, Baljendra S Kapoor2
1Research Author, Cleveland Clinic, Cleveland, Ohio.
Summary
Diverticulosis is the most frequent cause of acute lower gastrointestinal bleeding (GIB). Diagnostic imaging like CT angiography and colonoscopy help locate bleeding, with interventions ranging from embolization to surgery if conservative methods fail.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Interventional Radiology
Background:
- Diverticulosis is the leading cause of acute lower gastrointestinal bleeding (GIB).
- Initial management is typically conservative, with diagnostic tests reserved for persistent bleeding.
- Various imaging modalities are available for investigating acute lower GIB.
Framework:
- Colonoscopy offers direct visualization and therapeutic intervention for GIB.
- CT angiography (CTA) is a noninvasive tool for identifying active bleeding or lesions.
- Red blood cell (RBC) scans, particularly with SPECT, aid in localizing intermittent bleeding.
Implementation:
- For hemodynamically unstable patients, CTA and transcatheter arteriography/embolization are options.
- Colonoscopy may be considered in unstable patients if rapid preparation is feasible.
- Transcatheter embolization is effective when extravasation is visible, often in unstable patients.
Implications:
- Surgery is reserved for cases where colonoscopy and embolization fail to achieve hemostasis.
- Capsule endoscopy and CT enterography aid in diagnosing obscure or recurrent bleeding.
- The American College of Radiology Appropriateness Criteria guide imaging and treatment decisions based on evidence and expert consensus.
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