Multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: when, why and how?

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.

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.

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.