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

Abstract

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.

Value of multiphase computed tomography for gastrointestinal bleeding before endovascular treatment in hemodynamically unstable patients

“…Despite the plethora of published data related to the endovascular treatment of GIB, the interval between hospital admission or acute symptom presentation and conventional angiography has not been evaluated in most studies. The previous two studies analyzing the time to angiography yielded conflicting results (18,19). The discordance between results may be explained by the differences in hemodynamic status of the enrolled study population.…”

Endoscopic hemostasis makes the difference: Angiographic treatment in patients with lower gastrointestinal bleeding

“…The probability of contrast medium outflow in the CTA is maximized in patients who receive a CTA < 60 min earlier. However, the time period between the primary investigation and angiography had no significant impact on the demonstration of contrast medium outflow[ 27 ].…”

“…Early diagnostic investigation by radiological procedures appears to be justified in hemodynamically unstable patients with no hemostasis in primary endoscopy. In cases of proven bleeding, a CA should be performed immediately after the CTA[ 27 ]. When CTA shows no evidence of bleeding, the decision to perform a CA should be made individually in each patient, because a CTA may yield false-negative findings in rare cases[ 28 ].…”

“…In view of the fact that the patients usually underwent two diagnostic endoscopies, this time interval is indicative of smooth cooperation between the involved specialties, although the published guidelines provide no recommendations about the ideal time point for CA[ 8 ]. Interestingly, and analogous to endoscopic investigation, bleeding is detected on angiography more easily when the examination is performed early after the detection of bleeding on CTA[ 27 ].…”

“…A rising number of transfusions was shown to be a predictor of clinical failure in the treatment of LGIB[ 11 , 33 ]. Furthermore, the probability of detecting bleeding on angiography is significantly higher[ 27 ]. Not surprisingly, the number of transfusions is an important parameter of variable importance and was of crucial significance in our results.…”