Obscure Gastrointestinal Bleeding: Evaluation with 64-Section Multiphase CT Enterography—Initial Experience

Huprich, James E.; Fletcher, Joel G.; Alexander, Jeffrey A.; Fidler, Jeff L.; Burton, Sharon S.; McCullough, Cynthia H.

doi:10.1148/radiol.2462061920

Cited by 139 publications

(91 citation statements)

References 36 publications

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“…Importantly, there are data suggesting that CT may be complimentary to capsule endoscopy. For example, in a study of 22 patients with occult gastrointestinal bleeding, MDCT was positive in 10/22 (45%) patients [46]. Eight of these patients were confirmed to have positive findings on capsule endoscopy or subsequent clinical diagnosis, and CT enterography identified three lesions, which were undetected on capsule endoscopy [47].…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a modification to ''standard'' abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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Section: Gastrointestinal Bleedingmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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“…Technique.-Recently, a multiphasic CT enterography-enteroclysis protocol has been introduced for evaluation of OGIB (13). Because of the requirement for rapid, multiphase imaging, this technique should be performed on at least a 16-row multidetector scanner.…”

Section: Ct Enterography and Enteroclysismentioning

confidence: 99%

“…After a 6-hour fast, patients are given a total of 1200-1600 mL of neutral oral contrast agent, either through a tube at a rate of 60-120 mL/min (CT enteroclysis) or divided into four oral doses given every 20 minutes, beginning 60 minutes before scanning; the last dose is administered with the patient on the CT table just before scanning (CT enterography). Intravenous administration of a spasmolytic drug is essential before image acquisition to minimize patient discomfort and bowel motion artifact (11)(12)(13).…”

Section: Ct Enterography and Enteroclysismentioning

confidence: 99%

Gastroenterologic and Radiologic Approach to Obscure Gastrointestinal Bleeding: How, Why, and When?

Graça¹,

Freire²,

Brito³

et al. 2010

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Gastrointestinal (GI) bleeding is a common clinical condition that is increasingly seen in an aging population and frequently requires hospitalization and intervention, with significant morbidity and mortality. Obscure GI bleeding (OGIB) is defined as loss of blood with no source identified after upper endoscopy and colonoscopy. Whether an obscure site of bleeding is clinically evident or silent, it constitutes a diagnostic and therapeutic challenge for the clinician. Gastroenterology and radiology provide the essential diagnostic tools used to evaluate suspected OGIB, each with its strengths and weaknesses. Small bowel series and conventional enteroclysis have a limited role in OGIB. Computed tomographic (CT) enterography and CT enteroclysis are noninvasive techniques with promising results in evaluation of small bowel disease and silent OGIB. CT angiography is a useful triaging tool for diagnosing or excluding active GI hemorrhage, localizing the site of bleeding, and guiding subsequent treatment. Tagged red blood cell scanning is the most sensitive technique for detection of active GI bleeding and allows imaging over a prolonged period, making it useful for detecting intermittent bleeding. Capsule endoscopy has emerged as an important tool for investigating OGIB, but it may soon have competition from double-balloon enteroscopy, a diagnostic technique that can also facilitate therapy.

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“…The technique utilizes luminal distention after ingestion of a large volume of contrast, thereby permitting visualization of mucosal details and vasculature. A recent study in patients with OGIB using multiphase CTE reported a diagnostic yield of 45% [Huprich et al 2008]. The main limitation of this technique arises because of inadequate bowel distention with oral contrast secondary to bowel obstruction, GI dysmotility, patient intolerance, and in patients with kidney insufficiency due to limitation in using contrast.…”

Section: Angiographymentioning

confidence: 99%

Therapeutic management options for patients with obscure gastrointestinal bleeding

Kochhar

Sanaka

Vargo

2011

Therap Adv Gastroenterol

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Obscure gastrointestinal bleeding (OGIB) is one of the most challenging disorders faced by gastroenterologists because of its evasive nature and difficulty in identifying the exact source of bleeding. Recent technological advances such as video capsule endoscopy and small bowel deep enteroscopy have revolutionized the diagnosis and management of patients with OGIB. In this paper, we review the various diagnostic and therapeutic options available for the management of patients with OGIB.

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Obscure Gastrointestinal Bleeding: Evaluation with 64-Section Multiphase CT Enterography—Initial Experience

Cited by 139 publications

References 36 publications

CT enterography: review of technique and practical tips

CT enterography: review of technique and practical tips

Gastroenterologic and Radiologic Approach to Obscure Gastrointestinal Bleeding: How, Why, and When?

Therapeutic management options for patients with obscure gastrointestinal bleeding

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