Multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: when, why and how?
Alberto Martino1, Marco Di Serafino2, Francesco Manguso1
1Department of Gastroenterology and Digestive Endoscopy, AORN "Antonio Cardarelli", Napoli, Italy.
Insights
Multidetector-row computed tomography angiography (MDCTA) shows promise as an adjunct tool for diagnosing non-variceal upper gastrointestinal bleeding (NVUGIB), particularly in severe or rare cases. Further research is needed to establish its role alongside esophagogastroduodenoscopy.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Non-variceal upper gastrointestinal bleeding (NVUGIB) is a frequent emergency with high morbidity and mortality.
- Esophagogastroduodenoscopy (EGD) is the primary diagnostic and treatment method for NVUGIB.
- Multidetector-row computed tomography angiography (MDCTA) has a limited role in NVUGIB diagnosis, though guidelines are evolving.
Purpose of the Study:
- To review current and potential indications for MDCTA in diagnosing NVUGIB.
- To discuss the technical aspects of MDCTA for NVUGIB.
- To evaluate MDCTA's role as an adjunct to EGD.
Main Methods:
- Comprehensive literature search of PubMed, EMBASE, and Google Scholar.
- Review focused on studies published up to May 2025.
- Analysis of MDCTA's diagnostic utility in NVUGIB.
Main Results:
- MDCTA is a promising adjunct diagnostic tool for NVUGIB.
- MDCTA is particularly useful in clinically severe NVUGIB cases.
- MDCTA may aid in diagnosing NVUGIB from rare, non-peptic sources.
Conclusions:
- While EGD is the standard, MDCTA shows potential as a complementary diagnostic modality.
- Evidence supporting MDCTA in NVUGIB is currently limited.
- Further studies are required to fully elucidate MDCTA's role in NVUGIB management.
Introduction:
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. According to current gastroenterological guidelines, esophagogastroduodenoscopy (EGD) represents the first-line modality for both diagnosis and treatment of NVUGIB. As opposed to lower gastrointestinal bleeding, multidetector-row computed tomography angiography (MDCTA) has a limited and no well-established role in the diagnostic process of NVUGIB. However, gastroenterological guidelines mainly focus on peptic-related NVUGIB only. Moreover, the adoption of MDCTA in NVUGIB has recently been encountered in radiological guidelines for special situations.
Areas Covered:
The aim of our study was to comprehensively review and discuss the current and potential indications of MDCTA and its technical aspects in the diagnostic process of NVUGIB. A comprehensive literature search of PubMed, EMBASE, and Google Scholar databases was conducted through May 2025 to identify pertinent studies.
Expert Opinion:
Although EGD undoubtedly represents the cornerstone in both diagnosis and treatment of most NVUGIB cases, MDCTA has emerged as a promising adjunct diagnostic tool, especially among clinically severe cases and those due to rare, non-peptic sources. However, evidence is still scarce, and further studies are needed to clarify its role in this scenario.
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