American College of Radiology
ACR Appropriateness Criteria®

Radiologic Management of Lower Gastrointestinal Tract Bleeding

Variant 1: Lower GI tract bleeding. Active bleeding with hematochezia or melena in a hemodynamically stable patient. Next procedure/intervention.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Transcatheter arteriography/intervention (TAI) May be appropriate TBD TBD 5 n/a 0 0 0 0 0 0 0 0 0
Diagnostic/therapeutic colonoscopy Usually appropriate TBD TBD 8 n/a 0 0 0 0 0 0 0 0 0
Surgery Usually not appropriate TBD TBD 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m labeled RBC scan abdomen and pelvis Usually appropriate ☢☢☢ 1-10 mSv 7 n/a 0 0 0 0 0 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually appropriate ☢☢☢☢☢ 30-100 mSv 7 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Lower GI tract bleeding. Active bleeding in a hemodynamically unstable patient or a patient who has required more than 5 units of blood. Next procedure/intervention.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Transcatheter arteriography/intervention (TAI) Usually appropriate TBD TBD 8 n/a 0 0 0 0 0 0 0 0 0
Diagnostic/therapeutic colonoscopy May be appropriate TBD TBD 4 n/a 0 0 0 0 0 0 0 0 0
Surgery May be appropriate TBD TBD 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m labeled RBC scan abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
CTA abdomen and pelvis with IV contrast May be appropriate ☢☢☢☢☢ 30-100 mSv 5 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Lower GI tract bleeding. Colonoscopy localized the bleeding siteand treatment was attempted. Ongoing or recurrent bleeding. Next procedure/intervention.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Transcatheter arteriography/intervention (TAI) Usually appropriate TBD TBD 8 n/a 0 0 0 0 0 0 0 0 0
Diagnostic/therapeutic colonoscopy May be appropriate TBD TBD 4 n/a 0 0 0 0 0 0 0 0 0
Surgery Usually appropriate TBD TBD 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m labeled RBC scan abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv 2 n/a 0 0 0 0 0 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢☢☢ 30-100 mSv 3 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Lower GI tract bleeding. Intermittent or obscure nonlocalized recurrent bleeding. Next procedure/intervention (assumes prior negative endoscopy).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Transcatheter arteriography/intervention (TAI) May be appropriate TBD TBD 4 n/a 0 0 0 0 0 0 0 0 0
Diagnostic/therapeutic colonoscopy May be appropriate TBD TBD 5 n/a 0 0 0 0 0 0 0 0 0
Surgery Usually not appropriate TBD TBD 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m labeled RBC scan abdomen and pelvis Usually appropriate ☢☢☢ 1-10 mSv 7 n/a 0 0 0 0 0 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually appropriate ☢☢☢☢☢ 30-100 mSv 8 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Capsule endoscopy Usually appropriate TBD TBD 8 n/a 0 0 0 0 0 0 0 0 0
Contrast small bowel radiography Usually not appropriate TBD TBD 2 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.