What is the role of MDCTA in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Multidetector CT angiography (MDCTA) has increasingly been adopted for the diagnosis of acute GI bleeding. [66] Because CT scanning can be acquired rapidly and is nearly universally available in the acute setting, it may be an ideal initial diagnostic test for patients who are unstable with UGIB or lower GI bleeding with failed endoscopy or have a source of bleeding seen on an additional imaging modality. [67]

CTA appears to have a high negative predictive value (NPV) for the identification of obscure GI bleeding that may be useful for excluding patients who are unlikely to benefit from transcatheter mesenteric angiography. [68] In a retrospective study of 20 patients who underwent 20 negative CTA evaluations to assess and treat GI bleeding followed by mesenteric angiography, 18 of the 20 patients also had negative subsequent MA (NPV = 90%). [68] The remaining two cases were false negatives, with UGIB (< 0.05). The authors concluded CTA may be considered as a first-line diagnostic study for evaluating obscure GI bleeding, and this diagnostic modality could avoid the associated costs, risks, and challenges associated with transcatheter mesenteric angiography. [68]


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