Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin

Friebe, Björn; Wieners, Gero

doi:10.1007/s00068-011-0128-z

Cited by 13 publications

(16 citation statements)

References 75 publications

(108 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Th ere is a wide range of reported sensitivities (33-93%), specifi city (30-95%), diagnostic yields (26-87%), and localization accuracy (19-100%) for scintigraphy throughout the GI tract ( 164,(171)(172)(173)(174)(175)(176)(177)(178)(179)(180). Because bleeding is intermittent, scintigraphy may be helpful in identifying the site of bleeding when other diagnostic tests have been negative (180)(181)(182).…”

Section: Scintigraphy 99mmentioning

confidence: 97%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

View full text Add to dashboard Cite

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

show abstract

Section: Scintigraphy 99mmentioning

confidence: 97%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

View full text Add to dashboard Cite

show abstract

“…Although the specific technical parameters used and the phase images acquired vary among institutions, most agree that three-phase examinations that include the unenhanced, arterial, and portal venous phases provide the best and most reproducible results for this clinical application in patients with acute gastrointestinal bleeding (6,7,14,19,29,32,33,36). For CT scanners with a detector configuration of 64 × 0.625 mm, the following acquisition parameters are recommended: section thickness, 1 mm, with a reconstruction interval of 0.8 mm; pitch factor, 0.828; rotation time, 0.5 second; and tube voltage, 120 kV, with automatic tube current modulation in the x-, y-, and z-axis directions.…”

Section: Imaging Techniquementioning

confidence: 99%

“…Temporally resolved CT angiography allows the identification of active extravasation of contrast material and the accurate identification of the source of hemorrhage (22,27). Other advantages of CT angiography include its widespread availability in the emergency setting, its minimal invasiveness, and its reproducible results, which combine high sensitivity and accuracy for detecting or excluding active bleeding, as well as detecting the potential source and cause (7,9,19,(28)(29)(30)(31)(32)(33)(34)(35). CT angiography can be used to evaluate the wall of the entire gastrointestinal tract and other digestive structures that may occasionally be the source of bleeding, such as the pancreas and biliary tract (Fig 3).…”

Section: Multidetector Ct Angiographymentioning

confidence: 99%

“…In addition, acute gastrointestinal bleeding frequently occurs as a complication in critically ill adults who are admitted with other primary diagnoses and complicates their clinical course (1). Mortality ranges between 19% and 40% and increases with (a) older age, (b) the presence of shock, and (c) associated underlying comorbidities (6)(7)(8). Variceal hemorrhage is associated with a mortality rate of 15%-40%, a rate higher than that from other causes of acute gastrointestinal bleeding (1,9).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multidetector CT Angiography for Acute Gastrointestinal Bleeding: Technique and Findings

Martín¹,

Martí²,

Soto³

et al. 2013

RadioGraphics

104

View full text Add to dashboard Cite

Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.

show abstract

“…Due to advances in spatial and time resolution, the use of three-dimensional maximum intensity projections and multiplanar reconstructions, and the ability to detect bleeding as slow as 0.3 ml/min, CT angiography is more sensitive than angiography for localizing the bleeding site [3]. Additionally, CT can provide additional clues regarding the etiology of bleeding.…”

mentioning

confidence: 99%

Focus on gastrointestinal bleeding

Kilic

2011

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin

Cited by 13 publications

References 75 publications

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Multidetector CT Angiography for Acute Gastrointestinal Bleeding: Technique and Findings

Focus on gastrointestinal bleeding

Contact Info

Product

Resources

About