The role of enhanced multi‐detector‐row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding

Miyaoka, Youichi; Amano, Yuji; Ueno, Sayaka; Izumi, Daisuke; Mikami, Haruo; Yazaki, Tomotaka; Okimoto, Eiko; Sonoyama, Takayuki; Ito, Satoko; Fujishiro, Hirofumi; Kohge, Naruaki; Imaoka, Tomonori

doi:10.1111/jgh.12447

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…Although not yet recommended by the international guideline (10) and the latest guidelines in Japan (20,21), the usefulness of non-contrast and contrast CT for UGIB has also been shown (22).…”

Section: Discussionmentioning

confidence: 99%

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Kawaguchi¹,

Kurumi²,

Takeda³

et al. 2017

Ann. Transl. Med.

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Background: Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities.Methods: A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients.Results: Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities. Conclusions:The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65.

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Section: Discussionmentioning

confidence: 99%

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Kawaguchi¹,

Kurumi²,

Takeda³

et al. 2017

Ann. Transl. Med.

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Section: Discussionmentioning

confidence: 99%

“…Recently, the introduction of MDCT has led to increased image resolution and decreased scanning time [ 13 ], and this may be a useful modality for detecting bleeding foci in patients with massive GI bleeding. A previous study showed that MDCT had a moderate diagnostic accuracy in patients with non-variceal bleeding (50.2%); however, it had a diagnostic accuracy of 96.4% in patients with variceal bleeding [ 13 ]. Therefore, we evaluated the risk by adding CT scores to GBS, whereby 90% of patients who come to the ER from UGI bleeding are classified as high-risk, which we define as ‘evidence of active bleeding on MDCT, having liver cirrhosis or varix.’ Analysis of risk from GBS-CT showed a significant difference in transfusion amount according to the risk groups; however, the GBS score alone was insufficient to show this trend, as there was no blood transfusion in the low- and moderate risk groups.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room

Lee

Jung

Kim

et al. 2022

Korean J Intern Med

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Background/Aims: Acute upper gastrointestinal (UGI) bleeding is a significant emergency situation with a mortality rate of 2% to 10%. Therefore, initial risk stratification is important for proper management. We aimed to evaluate the role of contrast-enhanced multidetector computed tomography (MDCT) for risk stratification in patients with acute UGI bleeding in the emergency room (ER).Methods: This retrospective study included patients with UGI bleeding in the ER. Glasgow-Blatchford risk score-computed tomography (GBS-CT) was assessed using a combination of GBS and the MDCT scan scoring system.Results: Of the 297 patients with UGI bleeding, 124 (41.8%) underwent abdominal MDCT. Among them, 90.3% were classified as high-risk by GBS, and five patients died (4.0%). Rebleeding occurred in nine patients (7.3%). The high-risk GBS-CT group had significantly higher in-hospital mortality (10.5% in high-risk vs. 1.4% in moderate risk vs. 0% in low-risk, p = 0.049), transfusion amount (p < 0.001), and endoscopic hemostasis (p < 0.001) compared to the moderate- and low-risk groups.Conclusions: Adding MDCT scans to the existing validated prognosis model when predicting the risk of UGI bleeding in patients in the ER plays a significant role in determining in-hospital mortality, transfusions, and the need for endoscopic hemostasis.

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“…Nonetheless, EGD has considerable limitations in the diagnosis of patients with massive bleeding or other co-morbidities, and often fails to assess the source of bleeding. In this aspect, MDCT was considered to be an outstanding diagnostic method due to its rapidity, spectrum of availability, and minimal invasiveness [ 14 – 16 ]. A prospective study of patients with UGIB who underwent EGD after MDCT showed that the sensitivity of this latter methodology to identify the location and the etiology of bleeding was 100% and 90.9%, respectively [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of contrast-enhanced multi-detector computed tomography in identifying upper gastrointestinal bleeding: A retrospective study of patients admitted to the emergency department

Kim

et al. 2022

PLoS ONE

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Upper gastrointestinal bleeding (UGIB) is a major cause of clinical deterioration worldwide. A large number of patients with UGIB cannot be diagnosed through endoscopy, which is normally the diagnostic method of choice. Therefore, this study aimed to investigate the diagnostic value of multi-detector computed tomography (MDCT) for patients with suspected UGIB. In this retrospective observational study of 386 patients, we compared contrast-enhanced abdominopelvic MDCT to endoscopy to analyze the performance of MDCT in identifying the status, location of origin, and etiology of UGIB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were examined. In the assessment of bleeding status, MDCT was able to accurately identify 32.9% (21.9–43.9, 95% confidence interval [CI]) of patients with active bleeding, 27.4% (18.9–35.9, 95% CI) of patients with recent bleeding, and 94.8% (91.8–97.8, 95% CI) of patients without bleeding evidence (P<0.001). MDCT showed an accuracy of 60.9%, 60.6%, and 50.9% in identifying bleeding in the esophagus, stomach, and duodenum, respectively (P = 0.4028). The accuracy in differentiating ulcerative, cancerous, and variceal bleeding was 58.3%, 65.9%, and 56.6%, respectively (P = 0.6193). MDCT has limited use as a supportive screening method to identify the presence of gastrointestinal bleeding.

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The role of enhanced multi‐detector‐row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding

Abstract: Enhanced MDCT preceding urgent endoscopy may be an effective modality for the detection of bleeding origin in patients with acute upper GI bleeding.

Cited by 9 publications

References 14 publications

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room

Usefulness of contrast-enhanced multi-detector computed tomography in identifying upper gastrointestinal bleeding: A retrospective study of patients admitted to the emergency department

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