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Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a
Marco Di Serafino1, Alberto Martino2, Francesco Manguso3
1Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy. marco.diserafino@aocardarelli.it.
Insights
Multidetector-row computed tomography angiography shows promise for diagnosing severe non-variceal upper gastrointestinal bleeding, identifying bleeding status, site, and etiology. Further research is needed to confirm its role in clinical practice.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Non-variceal upper gastrointestinal bleeding is a common emergency with high morbidity and mortality.
- Upper gastrointestinal endoscopy is the current gold standard for diagnosis and treatment.
- Multidetector-row computed tomography angiography (MDCT-CTA) is emerging as a valuable tool for diagnosing non-variceal upper gastrointestinal bleeding, particularly in severe cases.
Purpose of the Study:
- To retrospectively evaluate the diagnostic performance of emergent MDCT-CTA in identifying the status, site, and etiology of severe non-variceal upper gastrointestinal bleeding.
- To assess MDCT-CTA's effectiveness when performed before or after urgent upper endoscopy.
Main Methods:
- Retrospective review of institutional databases for patients with severe non-variceal upper gastrointestinal bleeding undergoing emergent MDCT-CTA.
- Comparison of MDCT-CTA findings with reference standards including endoscopy, digital subtraction angiography, surgery, and pathology.
- Analysis of diagnostic performance metrics such as sensitivity, specificity, and accuracy.
Main Results:
- MDCT-CTA demonstrated a sensitivity of 77.8% and accuracy of 75% for diagnosing bleeding status.
- The sensitivity for identifying the bleeding site and etiology was high, at 92.4% and 79%, respectively.
- A total of 68 patients (38 men, median age 69 years) were included in the study.
Conclusions:
- MDCT-CTA is a feasible and effective imaging modality for detecting the site, status, and etiology of severe non-variceal upper gastrointestinal bleeding.
- MDCT-CTA may play a crucial role in managing selected severe cases, guiding treatment timing and type.
- Larger prospective studies are required to fully elucidate the role of MDCT-CTA in the diagnostic pathway for acute non-variceal upper gastrointestinal bleeding.
Background:
Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking.
Aim:
The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding.
Methods:
Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3 h) or following (< 3 h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards.
Results:
A total of 68 patients (38 men, median age 69 years [range 25-96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5-87.3), 40% (95% CI: 5.3-85.3), and 75% (95% CI: 63.0-84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2-97.5) and 79% (95% CI: 66.8-88.3), respectively.
Conclusion:
Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.
