Acute Lower Gastrointestinal Bleeding: Temporal Factors Associated With Positive Findings on Catheter Angiography After <sup>99m</sup>Tc-Labeled RBC Scanning

Chung, Maggie; Dubel, Gregory J.; Noto, Richard B.; Yoo, Don C.; Baird, Grayson L.; Prince, Ethan A.; Murphy, Timothy P.; Haaga, Timothy L; Ahn, Sun Ho

doi:10.2214/ajr.15.15380

Cited by 13 publications

(10 citation statements)

References 11 publications

(14 reference statements)

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“…Any benefit of shorter times to angiography could not be examined as only 17% (8/48) were performed in under 90 min 53. Similarly a case series of 120 patients with LGIB undergoing red cell scanning found that delays in performing angiography were associated with a reduced chance of demonstrating extravasation of contrast on the angiogram 52. Embolisation is used to control bleeding in a number of other clinical scenarios, including major trauma, UGIB and post partum haemorrhage.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

236

241

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

236

241

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“…Several studies have shown that more severe bleeds correlate to positive bleeding on TAI. [11] is study did demonstrate a positive relationship between units of pRBCs in the prior 24 h with successful angiography, Table 3. is finding corroborates several prior studies, which have shown that as bleeding severity increases, demonstrated by a drop in hemoglobin and increasing transfusions, the probability of finding a bleed also increases.…”

Section: Discussionmentioning

confidence: 88%

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

Brahmbhatt

Rao

Cantos

et al. 2020

JCIS

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Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

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“…The success rate for identification of active contrast material extravasation at fluoroscopic angiography is variable and depends on many factors, such as the location and rate of bleeding (24)(25)(26). The number of cases of active bleeding detected at fluoroscopic angiography has been shown to decrease with increasing time between RBC scintigraphic detection of bleeding and initiation of the angiographic evaluation (27).…”

Section: Endoscopic Evaluation Of Acute Gi Bleedingmentioning

confidence: 99%

“…CT angiography is widely available, and with appropriate triage, an angiogram may be acquired within a few minutes. Shortening the delay prior to evaluation is important, given that even a massive hemorrhage can start and stop rapidly over time and lengthening the time between the start of known bleeding and the subsequent implementation of radiologic evaluation results in fewer positive-result examinations (27,30).…”

Section: Ct Evaluation Of Acute Gi Bleedingmentioning

confidence: 99%

CT for Evaluation of Acute Gastrointestinal Bleeding

et al. 2018

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Acute gastrointestinal (GI) bleeding is common and necessitates rapid diagnosis and treatment. Bleeding can occur anywhere throughout the GI tract and may be caused by many types of disease. The variety of enteric diseases that cause bleeding and the tendency for bleeding to be intermittent may make it difficult to render a diagnosis. The workup of GI bleeding is frequently prolonged and expensive, with examinations commonly needing to be repeated. The use of computed tomography (CT) for evaluation of acute GI bleeding is gaining popularity because it can be used to rapidly diagnose active bleeding and nonbleeding bowel disease. The CT examinations used to evaluate acute GI bleeding include CT angiography and multiphase CT enterography. Understanding the clinical evaluation of acute GI bleeding, including the advantages and limitations of endoscopic evaluation, is necessary for the appropriate selection of patients who may benefit from CT. Multiphase CT enterography is used primarily to evaluate stable patients who have undergone upper and lower endoscopy without identification of a bleeding source. CT angiography is used to examine stable and unstable patients who respond to resuscitation, are believed to be actively bleeding, and are considered unlikely to have an upper GI source of hemorrhage. In the emergent setting, CT may yield critical information regarding the presence, location, and cause of active bleeding-data that can guide the choice of subsequent therapy. Recent developments in the use of and techniques for performing CT angiography have made it a potential first-line tool for evaluating acute GI bleeding. RSNA, 2018.

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Acute Lower Gastrointestinal Bleeding: Temporal Factors Associated With Positive Findings on Catheter Angiography After ^99mTc-Labeled RBC Scanning

Cited by 13 publications

References 11 publications

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

CT for Evaluation of Acute Gastrointestinal Bleeding

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Acute Lower Gastrointestinal Bleeding: Temporal Factors Associated With Positive Findings on Catheter Angiography After 99mTc-Labeled RBC Scanning

Cited by 13 publications

References 11 publications

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

CT for Evaluation of Acute Gastrointestinal Bleeding

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Acute Lower Gastrointestinal Bleeding: Temporal Factors Associated With Positive Findings on Catheter Angiography After ^99mTc-Labeled RBC Scanning