| 1. Lanas A, Dumonceau JM, Hunt RH, et al. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers 2018;4:18020. |
Review/Other-Dx |
N/A |
To focus on NVUGIB in the community setting, which is more common and less severe than NVUGIB in inpatient hospital settings, which occurs in association with hospitalizations due to other serious conditions (such as neurological, renal, cardiac, pulmonary, metabolic, traumatic or septic conditions). |
No results in abstract |
4 |
| 2. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol. 110(9):1265-87; quiz 1288, 2015 Sep. |
Review/Other-Dx |
N/A |
To provide recommendations on the diagnosis and management of small bowel bleeding. |
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. |
4 |
| 3. Ichita C, Sasaki A, Sumida C, et al. Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study. BMC Gastroenterol. 21(1):45, 2021 Feb 01. |
Review/Other-Dx |
8 patients with ADF |
To examine the clinical and the endoscopic characteristics of aorto-duodenal fistula (ADF) in eight patients who presented to our hospital. To clarify the diagnostic approach towards the disease. |
The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients' mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful. |
4 |
| 4. Feng W, Yue D, ZaiMing L, ZhaoYu L, Wei L, Qiyong G. Hemobilia following laparoscopic cholecystectomy: computed tomography findings and clinical outcome of transcatheter arterial embolization. Acta Radiol. 58(1):46-52, 2017 Jan. |
Review/Other-Dx |
14 patients treated for hemobilia following LC |
To assess computed tomography (CT) findings and clinical outcomes after transcatheter arterial embolization (TAE) in patients presenting with hemobilia following laparoscopic cholecystectomy (LC) . |
Abdominal CT provided the following signs of hemobilia: hematoma within the abdominal cavity and gallbladder fossa, blood clots containing high attenuation within the bile duct, biliary dilatation, pseudoaneurysm of the right hepatic artery, contrast extravasation, enhancement of the bile duct wall, and hypoperfusion of the right lobe. The success rate of TAE was 100% and rebleeding did not occur in any patient. Post-embolization syndrome and hepatic ischemia occurred in nine patients, which was associated with age and the time interval between the LC and TAE. |
4 |
| 5. Guglielmo FF, Wells ML, Bruining DH, et al. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. Radiographics. 41(6):1632-1656, 2021 Oct. |
Review/Other-Dx |
N/A |
To provide a practical resource for radiologists interpreting CT in patients with GI bleeding to facilitate standardized examination interpretation and improve the clarity and clinical impact of radiology reports. |
No results in abstract. |
4 |
| 6. Mullady DK, Wang AY, Waschke KA. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. [Review]. Gastroenterology. 159(3):1120-1128, 2020 09. |
Review/Other-Dx |
N/A |
To review the available evidence and best practice advice statements regarding the use of endoscopic therapies in treating patients with non-variceal upper gastrointestinal bleeding. |
No results in abstract. |
4 |
| 7. Wells ML, Hansel SL, Bruining DH, et al. CT for Evaluation of Acute Gastrointestinal Bleeding. [Review]. Radiographics. 38(4):1089-1107, 2018 Jul-Aug. |
Review/Other-Dx |
N/A |
To discuss the use of CT during evaluation of acute GI bleeding. |
No results in abstract. |
4 |
| 8. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. Correction to: ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol 2021;116:2309. |
Review/Other-Dx |
N/A |
To address predefined clinical questions to develop recommendations with the GRADE approach regarding management of patients with overt upper gastrointestinal bleeding. |
No results in abstract. |
4 |
| 9. Kim CY, Pinchot JW, Ahmed O, et al. ACR Appropriateness Criteria® Radiologic Management of Gastric Varices. J Am Coll Radiol 2020;17:S239-S54. |
Review/Other-Tx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for radiologic management of gastric varices. |
No results stated in abstract. |
4 |
| 10. Pinchot JW, Kalva SP, Majdalany BS, et al. ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension. J Am Coll Radiol 2021;18:S153-S73. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for radiologic management of portal hypertension. |
No results stated in abstract. |
4 |
| 11. Trabzonlu TA, Mozaffary A, Kim D, Yaghmai V. Dual-energy CT evaluation of gastrointestinal bleeding. [Review]. Abdom Radiol. 45(1):1-14, 2020 01. |
Review/Other-Dx |
N/A |
To discuss the role of dual-energy CT in the evaluation of gastrointestinal bleeding with potential advantages over conventional CT and limitations. |
No results in abstract. |
4 |
| 12. Mohammadinejad P, Kwapisz L, Fidler JL, et al. The utility of a dual-phase, dual-energy CT protocol in patients presenting with overt gastrointestinal bleeding. Acta Radiol Open. 10(7):20584601211030658, 2021 Jul. |
Observational-Dx |
176 consecutive patients with GI bleeding underwent a two-phase DE GI bleed CT protocol |
To estimate the performance of a dual-phase, dual-energy (DE) GI bleed CT protocol in patients with overt GI bleeding in clinical practice and examine the added value of portal phase and DE images. |
52 of 176 patients (29.5%) had GI bleeding by the reference standard. The overall sensitivity, specificity, and positive and negative predictive values of the CT GI bleed protocol for detecting GI bleeding were 65.4%, 89.5%, 72.3%, and 86.0%, respectively. In patients with GI bleeding, diagnostic confidence of readers increased after adding portal phase images to arterial phase images (p = 0.002), without additional benefit from dual energy images. In patients without GI bleeding, confidence in luminal extravasation appropriately decreased after adding portal phase, and subsequently DE images (p = 0.006, p = 0.018). |
2 |
| 13. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 14. Kim G, Soto JA, Morrison T. Radiologic Assessment of Gastrointestinal Bleeding. [Review]. Gastroenterol Clin North Am. 47(3):501-514, 2018 Sep. |
Review/Other-Dx |
N/A |
To discuss the radiologic assessment of patients using computed tomography (CT) angiography, CT enterography, conventional angiography, and nuclear scintigraphy. |
No results in abstract. |
4 |
| 15. Choi C, Lim H, Kim MJ, et al. Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding. BMC Gastroenterol. 20(1):426, 2020 Dec 14. |
Observational-Dx |
138 consecutive patients who underwent angiography with or without embolization for acute non-variceal GI bleeding |
To identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation. |
Of the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154-0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012). |
3 |
| 16. Chevallier O, Comby PO, Guillen K, et al. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis. [Review]. Diagn Interv Imaging. 102(7-8):479-487, 2021 Jul-Aug. |
Meta-analysis |
Fifteen studies (574 patients) |
To perform a systematic review and meta-analysis to determine the safety, efficacy, and outcomes of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) as the single embolic agent for the management of non-variceal upper and lower gastrointestinal bleeding (GIB). |
Fifteen studies with 574 patients were included. For upper GIB (331 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (328 of 331 patients) and 88.0% (237 of 300 patients), and 12.5% (69 of 314 patients) and 15.9% (68 of 331 patients), respectively. Thirty-day overall and major complications occurred in 14.3% (28 of 331 patients) and 2.7% (7 of 331 patients) of patients, respectively. For lower GIB (243 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (78 of 78 patients) and 78.0% (145 of 189 patients), and 15.7% (33 of 218 patients) and 12.7% (14 of 78 patients), respectively. Thirty-day overall and major complications occurred in 13.0% (25 of 228 patients) and 8.6% (19 of 228 patients) of patients, respectively. |
Inadequate |
| 17. Lai HY, Wu KT, Liu Y, Zeng ZF, Zhang B. Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding. Scand J Gastroenterol. 55(8):931-940, 2020 Aug. |
Observational-Dx |
158 patients with NVGIB underwent digital subtraction angiography |
To analyze the causes of acute non-variceal gastrointestinal bleeding (NVGIB) and to evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) for the treatment of NVGIB. |
Bleeding was confirmed in 71.5% (113/158) of performed angiographies, and 68 patients had visible contrast extravasation on angiography, with the other 45 patients having indirect signs of bleeding. Among the 113 patients with confirmed gastrointestinal bleeding, TAE was technically successful in 111 patients (98.2%). The mean procedure time required for TAE was 116 ± 44 min (ranging from 50 to 225 min). The primary total clinical success rate of TAE was 84.7% (94/111). The primary clinical success rates of TAE for vascular abnormality, neoplastic disease, and iatrogenic condition were 84.5% (49/58), 84.1% (37/44), and 88.9% (8/9), respectively. Intestinal necrosis and perforation were found in two patients after TAE. |
3 |
| 18. Shotar E, Soyer P, Barat M, et al. Diagnosis of acute overt gastrointestinal bleeding with CT-angiography: Comparison of the diagnostic performance of individual acquisition phases. Diagn Interv Imaging. 98(12):857-863, 2017 Dec. |
Observational-Dx |
49 patients with AOGIB |
To compare the respective values of arterial phase, portal venous phase and combination of phases using 64-section multidetector computed tomography (MDCT) for diagnosing acute overt gastrointestinal bleeding (AOGIB). |
AOGIB was identified in 28/49 patients (57%) with the multiphasic set, in 26/49 patients (53%) with arterial phase and in 25/49 patients (51%) with portal venous phase. Multiphasic set helped locate the bleeding site in 40/49 patients (82%). The cause was elucidated in 23/49 patients (47%) with multiphasic set. The differences between set performances were not statistically significant. Sensitivity for depicting AOGIB with the multiphasic set was 92% and specificity was 76%. |
3 |
| 19. Garcia-Blazquez V, Vicente-Bartulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol. 2013;23(5):1181-1190. |
Meta-analysis |
22 studies; 672 patients |
To assess the diagnostic accuracy of CTA in the evaluation of patients with an episode of acute GI hemorrhage. |
22 studies were included and provided data on 672 patients (range of age 5–74) with a mean age of 65 years. The overall sensitivity of CTA for detecting active acute GI hemorrhage was 85.2% (95% CI, 75.5% to 91.5%). The overall specificity of CTA was 92.1% (95% CI, 76.7% to 97.7%). The likelihood ratios for positive and negative test results were 10.8 (95% CI, 3.4 to 34.4) and 0.16 (95% CI, 0.1 to 0.27) respectively, with an area under the curve of 0.935 (95% CI, 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. |
M |
| 20. Fidler JL, Gunn ML, Soto JA, et al. Society of abdominal radiology gastrointestinal bleeding disease-focused panel consensus recommendations for CTA technical parameters in the evaluation of acute overt gastrointestinal bleeding. Abdom Radiol. 44(9):2957-2962, 2019 09. |
Review/Other-Dx |
N/A |
To formulate consensus recommendations for CT angiography technical parameters used to evaluate overt gastrointestinal (GI) bleeding. |
Consensus agreement was reached in 15/17 (89%) of the questions including the technique for the administration of IV contrast, the number of phases, scan timing, and image reconstruction. |
4 |
| 21. Sun H, Hou XY, Xue HD, et al. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: image quality, radiation dose and diagnostic performance. Eur J Radiol. 84(5):884-91, 2015 May. |
Observational-Dx |
112 consecutive patients with clinical signs of active GIB |
To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). |
There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P>0.05). Lower noise and higher SNR were found on VNE images than TNE images (P<0.05). Image quality of VNE was lower than that of TNE without significant difference (P>0.05). The active GIB source was identified in 84 patients, 83 (83/84, 98.8%) of which were confirmed by one or more reference standard. The AUC was 0.935±0.027 and 0.947±0.026 for protocols 1 and 2, respectively. There was no significant difference between protocols 1 and 2 for diagnostic performance (Z=1.672, P>0.05). The radiation dose reduction achieved by omitting the TNE acquisition was (30.11±6.32)%. |
1 |
| 22. Chan V, Tse D, Dixon S, et al. Outcome following a negative CT Angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38(2):329-35, 2015 Apr. |
Observational-Dx |
180 patients |
To evaluate the role of a negative CTA in patients who present with GI hemorrhage. |
A total of 180 patients had 202 CTAs during the 8-year period: 87 CTAs were performed for upper GI hemorrhage (18 positive for active bleeding, 69 negative) and 115 for LGIB (37 positive for active bleeding, 78 negative); 58.7% (37/63) of patients with upper GI bleed and 77.4% (48/62) of patients with LGIB who had an initial negative CTA did not rebleed without the need for radiological or surgical intervention. This difference was statistically significant (P=0.04). The relative risk of rebleeding, following a negative CTA, in LGIB vs upper GI bleeding patients is 0.55 (95% CI, 0.32–0.95). |
3 |
| 23. Tse JR, Shen J, Shah R, Fleischmann D, Kamaya A. Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding. Invest Radiol. 56(6):394-400, 2021 06 01. |
Observational-Dx |
50 consecutive patients with overt GIB and active extravasation on CTA |
To improve triage of patients with overt gastrointestinal bleeding (GIB) by correlating extravasation volume of first-pass CTA with bleeding rate and clinical outcomes. |
Fifty consecutive patients including 6 (12%) upper, 18 (36%) small bowel, and 26 (52%) lower GIB met inclusion criteria. Forty-two underwent catheter angiography, endoscopy, or surgery; 16 had intraprocedural active bleeding, and 24 required hemostatic therapy. Higher extravasation volumes correlated with hemostatic therapy (P = 0.007), intraprocedural active bleeding (P = 0.003), and massive transfusion (P = 0.0001), but not mortality (P = 0.936). Using a threshold volume of 0.80 mL or greater, the odds ratio of hemostatic therapy was 8.1 (95% confidence interval, 2.1-26), active bleeding was 11.8 (2.6-45), and massive transfusion was 18 (2.3-65). With mathematical modeling, extravasation volume had a direct and linear relationship with bleeding rate, and the lowest calculated detectable bleeding rate with CTA was less than 0.1 mL/min. |
3 |
| 24. Stewart K, Sharma AK. The utilization of CTA in management of gastrointestinal bleeding in a tertiary care center ED. Are we using it enough?. Am J Emerg Med. 39:60-64, 2021 01. |
Observational-Dx |
1493 patients |
To quantify how frequently CTA is being used in GI bleeding in our institution in relation to other diagnostic technologies, in light of validation of CTA for GI bleeding the literature.To evaluate if use of CTA inpatients seen for GI bleeding is associated with other resources currently utilized in treatment of GI bleeding such as red blood cell transfusion and patient length of stay. |
Retrospective chart review of 1493 patient (2012-2015), one - way ANOVA, and one-tail t-test, found CTA is used significantly less (0.7%) compared to classical endoscopy (75.7%, p < .001), video capsule endoscopy (VCE)(4.8%, p < .001), tagged red blood cell scintigraphy(4.4%, p < .001), and traditional catheter-directed angiography(2.88%, p < .001). In our subset of 11 CTA cases, we found mean time (in hours) to CTA was faster than mean time to endoscopy, 31:47 [95% CI: -7:50-71:24] and 42:44 [95% CI: 18:27-67:01] respectively. The difference in means between time to CTA and time to endoscopy did not achieve statistical significance, 12:57 h [95% CI -18:51-44:45; p = .40]. |
4 |
| 25. Hsu MJ, Dinh DC, Shah NA, et al. Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan. Abdom Radiol. 45(2):307-311, 2020 02. |
Observational-Dx |
35 consecutive patients with GI bleeding that received angiography for planned catheter-directed embolization |
To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding. |
The mean time from diagnostic study order to study completion was 3 h and 4 min for the CTA group and 5 h and 1 min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to intervention was 6 h and 8 min for the CTA group and 9 h and 29 min for the tagged RBC scan group, a statistically significant difference (p value = 0.028). |
3 |
| 26. Alrashidi I, Kim TH, Shin JH, Alreshidi M, Park M, Jang EB. Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience. Diagn Interv Radiol. 27(4):519-523, 2021 Jul. |
Review/Other-Dx |
9 patients underwent TAE for arterial esophageal bleeding |
To evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. |
The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. |
4 |
| 27. Aoki M, Tokue H, Koyama Y, Tsushima Y, Oshima K. Transcatheter arterial embolization with N-butyl cyanoacrylate for arterial esophageal bleeding in esophageal cancer patients. World J Surg Oncol. 14:54, 2016 Feb 24. |
Review/Other-Dx |
5 esophageal cancer patients underwent TAE with NBCA for the treatment of arterial esophageal bleeding |
To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding in esophageal cancer patients. |
All of the patients had bleeding from the esophageal artery and were in shock at the beginning of TAE. Four patients had a coagulopathy at the time of TAE; however, the TAE could successfully arrest bleeding in all five patients. After TAE, they immediately recovered from the shock state. Two patients were discharged without event, one patient is currently hospitalized for another complication, and the other two patients died due to multiorgan failure. In addition, no procedure-related complications such as esophageal infarction and recurrence of arterial esophageal bleeding were observed during this study. |
4 |
| 28. Kohli DR, Shah RD, Komorowski DJ, Smallfield GB. Periesophageal Pseudoaneurysms: Rare Cause of Refractory Bleeding Treated with Transarterial Embolization. Case Rep Gastrointest Med. 2016:1456949, 2016. |
Review/Other-Dx |
1 43-year-old female |
To report the first case of arterial bleeding from periesophageal pseudoaneurysms as well as use of angiographic embolization for arterial bleeding in the esophagus. |
A 43-year-old female with history of systemic lupus erythematosus, prior cytomegalovirus esophagitis treated with ganciclovir, and long segment Barrett's esophagus (Prague class C8 M9) with high grade dysplasia treated with radiofrequency ablation presented to the hospital with hematemesis. An upper gastrointestinal endoscopy showed multiple esophageal ulcers with active arterial spurting which could not be controlled with endoscopic interventions including placement of hemostatic clips. An emergent angiogram demonstrated actively bleeding saccular dilations (pseudoaneurysms) in the esophageal branches of the lower thoracic aorta as well as left gastric artery for which gelfoam and coil embolization was initially successful. Due to recurrence of massive bleeding, she subsequently underwent emergent esophagectomy and bipolar exclusion. Pathology demonstrated submucosal hemorrhage, esophagitis with dysplastic Barrett's mucosa, and an ulcer containing cytomegaloviral inclusions. |
4 |
| 29. Zheng L, Lee IJ, Shin JH, Chu HH, Li HL. Endovascular Management of Gastric Conduit Hemorrhage following Transthoracic Esophagectomy. J Vasc Interv Radiol. 32(8):1144-1149, 2021 Aug. |
Review/Other-Dx |
N/A |
To describe the authors' experience with angiography and TAE in 7 patients with massive bleeding of the gastric conduit after transthoracic esophagectomy. |
Endoscopy revealed ulcers in 5 patients, tumor recurrence in 1 patient, and unknown etiology in 1 patient. Arteriography revealed extravasation, pseudoaneurysm, or tumor blush arising from the intercostal artery (n = 4) or right gastric artery (n = 2), which were successfully embolized. The bleeding source was not identified in 1 patient, who died from persistent hemorrhage. |
4 |
| 30. Cho SB, Hur S, Kim HC, et al. Transcatheter arterial embolization for advanced gastric cancer bleeding: A single-center experience with 58 patients. Medicine (Baltimore). 99(15):e19630, 2020 Apr. |
Observational-Dx |
58 patients with gastric cancer treated with transcatheter arterial embolization |
To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers. |
Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7-1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0-24 units) (P = .02). |
2 |
| 31. Koo HJ, Shin JH, Shin S, Yoon HK, Ko GY, Gwon DI. Efficacy and Clinical Outcomes of Transcatheter Arterial Embolization for Gastrointestinal Bleeding from Gastrointestinal Stromal Tumor. J Vasc Interv Radiol. 26(9):1297-304.e1, 2015 Sep. |
Review/Other-Dx |
20 patients who underwent TAE for GI bleeding from GIST |
To evaluate the efficacy and clinical outcomes of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding from gastrointestinal stromal tumor (GIST). |
The sites of GIST-related bleeding or tumor staining were the jejunum (n = 9), stomach (n = 5), ileum (n = 3), duodenum (n = 2), and jejunum and colon (n = 1). Angiography showed bleeding from GIST in 5 patients, and tumor staining was noted in only 15 patients. TAE was performed for patients with and without contrast medium extravasation on angiography. Technical and clinical success rates of TAE were 95% (19 of 20 patients) and 90% (18 of 20 patients), respectively. Recurrent bleeding was noted in 1 patient. There were no procedure-related complications. In 15 patients, surgical resection of the tumors was performed after TAE. The 30-day and overall mortality rates were 10% (2 of 20 patients) and 30% (6 of 20 patients), respectively. |
4 |
| 32. Sun CJ, Wang CE, Wang YH, Xie LL, Liu TH, Ren WC. Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx. Indian J Cancer. 51 Suppl 2:e56-9, 2015 Feb. |
Review/Other-Dx |
5 patients |
To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with Onyx for acute gastrointestinal tumor hemorrhage. |
All the patients (100%) who underwent TAE with Onyx achieved complete hemostasis without rebleeding and the patients were discharged after clinical improvement without a second surgery. No one of the patients expired during the hospital course. All the patients were discharged after clinical improvement without a second surgery. Postembolization bowel ischemia or necrosis was not observed in any of the patients who received TAE with Onyx. |
4 |
| 33. Lee SM, Jeong SY, Shin JH, et al. Transcatheter arterial embolization for gastrointestinal bleeding related to pancreatic adenocarcinoma: clinical efficacy and predictors of clinical outcome. Eur J Radiol. 123:108787, 2020 Feb. |
Review/Other-Dx |
58 patients who underwent TAE for pancreatic adenocarcinoma-related GI bleeding |
To evaluate the clinical efficacy of transcatheter arterial embolization (TAE) for managing pancreatic adenocarcinoma-related gastrointestinal (GI) bleeding, and to determine the factors associated with clinical outcomes. |
On angiography, bleeding foci were detected in 47 patients (81%), while the other 11 patients showed tumor staining. Technical success rate was 98%, and first session and overall clinical success rates were 79% and 88%, respectively. N-butyl cyanoacrylate (NBCA) was the most commonly used embolic agent (53%). Stent-related bleeding was shown in 22 patients with characteristic angiogram such as arterial cut-off (13/22) and arteriobiliary fistula (5/22), with comparable clinical success rate (82%). Bleeding from the superior mesenteric artery (n = 3) at the first session of angiography and complications (n = 2), such as ischemic hepatitis and small bowel infarction, were all associated with a 30-day mortality. The overall 30-day mortality rate was 22%. Univariate analysis showed that massive transfusion and TNM stage 4 were related to clinical failure (P = 0.035 and 0.038, respectively). |
4 |
| 34. Zandrino F, Tettoni SM, Gallesio I, Summa M. Emergency arterial embolization of upper gastrointestinal and jejunal tumors: An analysis of 12 patients with severe bleeding. Diagn Interv Imaging. 98(1):51-56, 2017 Jan. |
Review/Other-Dx |
12 patients with severe bleeding from the upper gastrointestinal tract |
To retrospectively assess the efficacy of emergency percutaneous transcatheter arterial embolization in patients with severe bleeding due to upper gastrointestinal or jejunal tumor. |
Twelve embolization procedures were performed using various embolic agents. Embolization was achieved and bleeding was stopped in all patients. Five patients underwent surgery within the 30 days following embolization. In the remaining 7 patients, no bleeding occurred at 1 month follow-up in 6 patients and bleeding recurred in one patient at 1 month. In this later patient, endoscopic treatment was successful. |
4 |
| 35. Nykanen T, Peltola E, Kylanpaa L, Udd M. Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery. Scand J Gastroenterol. 52(5):523-530, 2017 May. |
Observational-Tx |
1583 hospital admissions |
To compare the safety, efficacy and feasibility of transcatheter arterial embolization (TAE) and surgery in the treatment of bleeding gastric and duodenal ulcers (BGDUs). |
During the study period, BGDUs lead to 1583 hospital admissions. TAE or surgery was necessary on 85 (5.4%) patients, 43 receiving surgery and 42 TAE. Out of 42, 16 received prophylactic TAE. Two underwent angiography and TAE to localize the bleeding. The remaining 24 received TAE for active or recurrent bleeding after endoscopy. The comparison of TAE (n = 24) and surgery (n = 43) included only patients with active or recurrent bleeding. Mortality rate was 12.5% after TAE and 25.6% after surgery (p = 0.347). Rebleeding rate was 25% after TAE and 16.3% after surgery (p = 0.641). Postprocedural complications were less frequent after TAE than surgery (37.5 vs. 67.4%, p = 0.018). Other secondary outcomes did not differ. Out of 85 procedures, 14 (16.5%) took place between midnight and 8 a.m., all nighttime interventions being surgeries. |
3 |
| 36. Laursen SB, Jakobsen M, Nielsen MM, Hovendal C, Schaffalitzky de Muckadell OB. Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy. Scand J Gastroenterol. 50(3):264-71, 2015 Mar. |
Observational-Tx |
118 patients treated with surgery or TAE for endoscopy-refractory PUB |
To identify the treatment of choice in endoscopy-refractory peptic ulcer bleeding (PUB). |
One hundred and eighteen patients were included. Patients treated with TAE had a higher CCI (mean: 2.33 vs 1.42; p = .003), and more severe anemia (mean: 6.8 vs 7.9 g/dl; p = .007) compared with patients treated with surgery. Surgery was associated with a higher rate of primary hemostasis (100% vs 91%; p = .007), lower rate of rebleeding (15% vs 40%; p = .004) but also higher rate of complications (60% vs 38%; p = .02) than TAE. Surgery was associated with an increased mortality (Odds ratio: 3.05; p = .033) when adjusting for confounding factors and excluding patients (n = 3) who were not candidates for both interventions. |
3 |
| 37. Mille M, Huber J, Wlasak R, et al. Prophylactic Transcatheter Arterial Embolization After Successful Endoscopic Hemostasis in the Management of Bleeding Duodenal Ulcer. J Clin Gastroenterol. 49(9):738-45, 2015 Oct. |
Observational-Dx |
117 patients treated for duodenal ulcer bleeding |
To demonstrate the new strategy of prophylactic transcatheter arterial embolization (TAE) of the gastroduodenal artery after endoscopic hemostasis of bleeding duodenal ulcers. |
The technical success of prophylactic TAE was 98% and the clinical success was 87% of cases. Rebleeding occurred in 11% of patients with prophylactic TAE and was successfully treated with repeated TAE or endoscopy. The major complication rate was 4%. Surgery was necessary in only 1 prophylactic TAE patient (0.9%) during the whole study period. Mortality associated with ulcer bleeding was 4% in patients with prophylactic TAE. |
4 |
| 38. Yao Z, Tian W, Xu X, et al. Transcatheter Arterial Embolization in the Treatment of Abdominal Bleeding in Patients Being Treated with Open Abdomen Due to Duodenal Fistula. World J Surg. 44(8):2562-2571, 2020 08. |
Observational-Dx |
131 patients (64=SH group and 67=TAE group) |
To investigate the transcatheter arterial embolization (TAE) in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula. |
A total of 131 patients were enrolled, and there were 64 in the surgical hemostasis (SH) group and 67 in the TAE group. The success rate of hemostasis was higher in the TAE group (89.55% vs. 73.44%, adjusted OR = 4.065, 95% CI 1.336-12.336, P = 0.013). Moreover, the recognition rate of hemorrhagic vessels in the TAE group was higher (91.04 vs. 51.56; P < 0.001). The re-bleeding occurred in 20 patients, 7(11.67%) in the TAE group and 13(27.66%) in the SH group. The re-bleeding rate in SH group was higher (adjusted HR = 2.564, 95% CI 1.023-6.428, P = 0.045) CONCLUSIONS: TAE is an effective method in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula. |
4 |
| 39. Wen F, Dong Y, Lu ZM, Liu ZY, Li W, Guo QY. Hemobilia After Laparoscopic Cholecystectomy: Imaging Features and Management of an Unusual Complication. Surg Laparosc Endosc Percutan Tech. 26(1):e18-24, 2016 Feb. |
Review/Other-Dx |
12 patients treated for hemobilia after LC |
To assess the imaging features and the management of hemobilia after laparoscopic cholecystectomy (LC). |
Risk factors for hemobilia included a variant ductal anatomy, a variant cystic artery, and intraoperative adhesion. Abdominal computed tomography (CT) could provide the diagnostic signs as follows: a hematocele in the abdominal cavity, the gallbladder fossa, and the bile duct, biliary dilation, pseudoaneurysm of the right hepatic artery, and contrast extravasations on contrast-enhanced CT. No rebleeding occurred after the transcatheter arterial embolization in all patients without immediate procedural complications. |
4 |
| 40. Lee NJ, Shin JH, Lee SS, Park DH, Lee SK, Yoon HK. Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage. Diagn Interv Imaging. 99(11):717-724, 2018 Nov. |
Review/Other-Dx |
12 patients |
To report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE). |
Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n=7), the right hepatic artery (n=3), the left gastric artery (n=1), the left accessory gastric artery (n=1) and gastroduodenal artery (n=1). TAE was performed with gelatin sponge particles (n=1), coil (n=1) and n-butyl-2 cyanoacrylate with/without coils (n=11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement. |
4 |
| 41. Huprich JE, Barlow JM, Hansel SL, Alexander JA, Fidler JL. Multiphase CT enterography evaluation of small-bowel vascular lesions. AJR Am J Roentgenol 2013;201:65-72. |
Review/Other-Dx |
N/A |
To review the unique patterns of enhancement and lesion morphology seen on multiphase CTE and how those findings enable detection and characterization of specific lesions in many cases. |
Because of the high prevalence in nonbleeding patients and frequent multiplicity of angioectasias, determining the clinical benefit from their detection by multiphase CTE and endoscopy is problematic. Although arterial lesions are less commonly encountered clinically, their detection is critically important because of a high risk of life-threatening bleeding. Along with wireless capsule endoscopy and balloon-assisted endoscopy, multiphase CTE is a useful tool for the evaluation of patients with obscure gastrointestinal bleeding due to small-bowel vascular lesions. |
4 |
| 42. Zhang, Sun, Xue, Li XG, Jin ZY. Computed Tomography Signs for Active Severe Gastrointestinal Bleeding. Chung Kuo I Hsueh Ko Hsueh Yuan Hsueh Pao. 38(3):322-6, 2016 06 10. |
Review/Other-Dx |
93 patients with active severe GIB |
To summarize the positive signs on multi-detector CT angiography (CTA) for active severe gastrointestinal bleeding (GIB). |
Intraluminal extravasation of contrast material was identified in 44 cases (47.3%),vascular malformation was found in 22 cases (23.7%),gastrointestinal tumor was detected in 18 cases (19.4%),focal or segmental abnormal bowel mucosal enhancement was present in 7 cases (7.5%),and diverticulum with abnormal enhancement was found in 2 cases (2.2%). |
4 |
| 43. Tseng CM, Lin IC, Chang CY, et al. Role of computed tomography angiography on the management of overt obscure gastrointestinal bleeding. PLoS ONE. 12(3):e0172754, 2017. |
Observational-Dx |
71 patients (25 patients with positive CTA findings and 46 patients with negative CTA findings) |
To evaluate the impact of computed tomography angiography (CTA) before enteroscopy for acute overt acute overt obscure gastrointestinal bleeding (OGIB). |
From February 2008 to March 2015, 71 patients including 25 patients with positive CTA findings and 46 patients with negative CTA findings, were enrolled. All 25 patients with positive CTA findings were confirmed to have mid GI lesions, a significantly higher proportion than among patients with negative CTA findings (100% vs. 52.2%, respectively; P <0.001). CTA had a higher diagnostic yield for bleeding from tumor origin than from non-tumor origin (80.0% vs. 23.7%, respectively; P <0.001). The diagnostic yield of CTA and enteroscopy was 35.2% and 73.2%, respectively. The lesions could be identified by the initial route of enteroscopy in more patients with positive CTA findings than in those with negative CTA findings (92.0% vs. 47.8%, respectively; P <0.001). Lesions could be identified in seven of the 25 patients (28.0%) with positive CTA findings by using only push enteroscopy instead of single-balloon enteroscopy (SBE), but all 46 patients with negative CTA findings needed SBE for deep small-bowel examination. |
4 |
| 44. Kokoroskos N, Naar L, Peponis T, et al. Provocative Angiography, Followed by Therapeutic Interventions, in the Management of Hard-To-Diagnose Gastrointestinal Bleeding. World J Surg. 44(9):2944-2949, 2020 09. |
Observational-Dx |
23 PROVANGIO exams |
To examine the ability of provocative angiography (PROVANGIO) to identify the bleeding source when conventional radiography fails. |
Twenty-three PROVANGIO were performed. Patients were predominantly male (15, 65.2%), and hematochezia was the most common presenting symptom (12, 52.2%). Patients with a positive PROVANGIO had lower Charlson comorbidity index (1 vs. 7, p = 0.009) and were less likely to have a prior history of GIB (14.3% vs. 87.5%, p = 0.001). PROVANGIO localized bleeding in 7 (30%) patients. In 6 out of 7 patients, the bleeding source was identified in the SMA and, in one case, in the IMA distribution. The bleeding was controlled angiographically in four cases, endoscopically in one case and surgically in the remaining two. No complications related to PROVANGIO were detected. |
3 |
| 45. Shin JH. Refractory gastrointestinal bleeding: role of angiographic intervention. Clin Endosc 2013;46:486-91. |
Review/Other-Tx |
N/A |
To understand the indications, principles, outcomes, and complications of transcatheter arterial embolization (TAE), as well as embolic materials available. |
No results in abstract |
4 |
| 46. Wildgruber M, Wrede CE, Zorger N, et al. Computed tomography versus digital subtraction angiography for the diagnosis of obscure gastrointestinal bleeding. Eur J Radiol. 88:8-14, 2017 Mar. |
Observational-Dx |
24 patients |
To prospectively evaluate the diagnostic yield of computed tomography angiography (CTA) versus digital subtraction angiography (DSA) for the diagnosis of major obscure gastrointestinal bleeding (OGIB). |
24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06). |
4 |
| 47. Kawabata H, Kawakatsu Y, Sone D, et al. A rare case of Goodpasture syndrome concomitant with bleeding jejunal Dieulafoy's lesion. Clin J Gastroenterol. 13(3):382-385, 2020 Jun. |
Review/Other-Dx |
1 81-year-old male |
To review a case of an 81-year-old man diagnosed with Goodpasture syndrome (GS). |
After starting plasmapheresis and steroid pulse therapy, he experienced tarry stool and contrast-enhanced CT revealed an aneurysmal finding in the jejunum. Paroral enteroscopy showed a jejunal Dieulafoy's lesion (DL) with gush-out hemorrhage. Hemostasis was successfully achieved by hemoclipping, and he then experienced no re-bleeding events. GS can present as a jejunal DL, and contrast-enhanced CT is useful for investigating the etiology and site of small intestinal bleeding, which can lead to smooth, effective endoscopic hemostasis. |
4 |
| 48. Batouli A, Kazemi A, Hartman MS, Heller MT, Midian R, Lupetin AR. Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding. Clin Radiol 2015;70:661-6. |
Review/Other-Dx |
N/A |
To summarize the pathophysiology, epidemiology, diagnosis, and management of Dieulafoy lesions with a focus on diagnostic findings at enhanced CT imaging. |
No results stated in abstract. |
4 |
| 49. Aksoy T. Obscure and occult gastrointestinal bleeding: role of radionuclide imaging. Abdom Imaging 2012;37:309-10; author reply 11-2. |
Review/Other-Dx |
N/A |
N/A |
No abstract available. |
4 |
| 50. Shukla PA, Zybulewski A, Kolber MK, Berkowitz E, Silberzweig J, Hayim M. No catheter angiography is needed in patients with an obscure acute gastrointestinal bleed and negative CTA. Clin Imaging. 43:106-109, 2017 May - Jun. |
Observational-Dx |
20 patients |
To evaluate the negative predictive power of computed tomography angiography (CTA) for the identification of obscure acute gastrointestinal (GI) bleeding (GI bleeding not visualized/treated by endoscopy) on subsequent mesenteric angiography (MA) with the intention to treat. |
20 patients (14 male, 6 female; average age: 73.1±12.8years) underwent 20 negative CTA examinations for the evaluation and treatment of GI bleeding followed by mesenteric angiography. Eighteen of 20 patients had negative subsequent MA (negative predictive value, NPV=90%). Both false negative cases were upper GI bleed (vs 0 lower GI bleed); this difference was significant (p<0.05). |
4 |
| 51. Pai M, Frampton AE, Virk JS, et al. Preoperative superselective mesenteric angiography and methylene blue injection for localization of obscure gastrointestinal bleeding. JAMA surgery 2013;148:665-8. |
Review/Other-Dx |
4 patients |
To describe 4 patients with OGIB who had preoperative localization of small-bowel bleeding sites using superselective mesenteric angiography (SSMA) and intraoperative methylene blue injection. |
Four patients had preoperative localization of the bleeding site with superselective mesenteric angiography, which was confirmed by the use of intraoperative methylene blue injection. This novel technique allowed us to identify the abnormal pathology, and, consequently, resection of the implicated segment of small bowel was performed without any postoperative complications. Final histology showed that 2 patients had arteriovenous malformations: one had a benign hemangioma of the small bowel, and the other had chronic ischemic ulceration in the ileum. |
4 |
| 52. Agrawal JR, Travis AC, Mortele KJ, et al. Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. Journal of gastroenterology and hepatology 2012;27:751-9. |
Observational-Dx |
52 patients |
To determine the diagnostic yield of dual-phase computed tomographic enterography (CTE) in patients with obscure GI bleeding and a non-diagnostic capsule endoscopy. |
Capsule endoscopy was performed in 52 patients; 26 patients (50%) had occult GI bleeding and 26 patients (50%) had overt GI bleeding. CTE was then performed in 25 of the 48 patients without a definitive source of bleeding seen on capsule endoscopy. The diagnostic yield of CTE was 0% (0/11) in patients with occult bleeding versus 50% (7/14) in patients with overt bleeding (P < 0.01). Using clinical follow up as the gold standard, for the 25 patients with a non-diagnostic capsule, CTE had a sensitivity of 33% (95% confidence interval 0.15, 0.56) and a specificity of 75% (95% confidence interval 0.22, 0.99). |
2 |
| 53. Chu Y, Wu S, Qian Y, et al. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography. Gastroenterol Res Pract 2016;2016:8367519. |
Observational-Dx |
121 patients |
To evaluate the complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) in the diagnosis of obscure gastrointestinal bleeding (OGIB). |
The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9%) but was significantly higher than the yield of CTE (87% versus 25%, p < 0.001). The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%, p < 0.001) and DBE (39.1% versus 17.4%, p = 0.013), while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE. |
4 |
| 54. Huprich JE, Fletcher JG, Fidler JL, et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology. 2011;260(3):744-751. |
Observational-Dx |
58 patients |
To compare the performance of multiphase CT enterography with that of CE in a group of patients with OGIB. |
58 adult patients, referred for the evaluation of OGIB (occult, 25 patients [43%]; overt, 33 patients [57%]), underwent both tests. A small bowel bleeding source was identified in 16/58 patients (28%). The sensitivity of CT enterography was significantly greater than that of CE (88% [14/16 patients] vs 38% [6/16 patients], respectively; P=.008), largely because it depicted more small bowel masses (100% [9/9 patients] vs 33% [3/9 patients], respectively; P=.03). No additional small bowel tumors were discovered during the follow-up period (range, 5.6–45.9 months; mean, 16.6 months). |
2 |
| 55. Jeon SR, Jin-Oh K, Gun KH, et al. Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding? The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2014;25:257-63. |
Observational-Dx |
98 patients, 99 cases |
To evaluate the efficacy of CT as a first-line study in OGIB and to determine whether the order of diagnostic methods makes a clinical difference. |
Overt OGIB was present in 92% of patients. Mucosal lesions (46%) were the most common diagnoses, while tumors accounted for 7%. The diagnostic yield of CE was significantly higher than that of CT for both groups (CT first group, p<0.001; CE first group, p=0.013). In the CT first group, the diagnostic yield using both CT and CE (48/75; 64%) was significantly higher than that for CT alone (12/75; 16%, p=0.005). In the CE first group, the diagnostic yield with both CT and CE versus CE alone was 70.9% versus 62.5%, respectively, with a significant difference (p=0.045). |
3 |
| 56. He B, Gong S, Hu C, et al. Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy. The British journal of radiology 2014;87:20140229. |
Observational-Dx |
82 patients to receive MSCT diagnosis and 67 patients to receive CE diagnosis |
To compare the diagnostic capabilities between capsule endoscopy (CE) and multislice CT (MSCT) enterography in combination with MSCT angiography for assessment of obscure gastrointestinal bleeding (OGIB). |
Administration of anisodamine markedly increased the satisfaction rate of bowel filling (94.67% vs 28.57%; p < 0.001) but not the diagnostic yield (p = 0.293) of MSCT. Compared with MSCT, CE showed an improved overall diagnostic yield (68.66% vs 47.56%; p = 0.010), which was also observed in overt bleeding patients (i.e. patients with continued passage of visible blood) (76.19% vs 51.02%; p = 0.013) and in patients aged younger than 40 years of age (85% vs 51.28%; p = 0.024). However, CE had similar positive rates to MSCT (p > 0.05). Among the 22 cases in whom both examinations were conducted, CE showed no significantly different diagnostic capability compared with MSCT (p = 0.4597). |
2 |
| 57. Chang WC, Tsai SH, Chang WK, et al. The value of multidetector-row computed tomography for localization of obscure acute gastrointestinal bleeding. Eur J Radiol. 80(2):229-35, 2011 Nov. |
Observational-Dx |
92 patients |
To use a risk scoring system to determine a cutoff value for performing MDCT and tried to establish the value of MDCT for localization of obscure AGIB. |
Of the 92 patients, 62 (67.4%) were classified as high-risk patients. Blatchford scores of high-risk patients were significantly greater than those of low-risk patients. Sensitivity for MDCT diagnosing obscure AGIB was 81% in high-risk patients, as compared with 50% in the low-risk. When used in conjunction with selection of the cut-off value of 13 in Blatchford scoring system, the sensitivity and specificity of MDCT were 70.9% and 73.7%, respectively. Contrast extravasation was the most specific sign of AGIB (k=.87), recognition of which would have improved diagnostic accuracy. |
2 |
| 58. Yen HH, Chen YY, Yang CW, Liu CK, Soon MS. Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding. World J Gastroenterol 2012;18:692-7. |
Observational-Dx |
31 patients |
To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB). |
From April 2004 to April 2010, a total of 75 patients underwent DBE for overt OGIB. Thirty one cases received MDCT followed by DBE for OGIB. The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%. The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%, P = 0.014). Additionally, the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%, P = 0.003). |
3 |
| 59. Casciani E, Nardo GD, Chin S, et al. MR Enterography in paediatric patients with obscure gastrointestinal bleeding. European Journal of Radiology. 93:209-216, 2017 Aug.Eur J Radiol. 93:209-216, 2017 Aug. |
Observational-Dx |
25 patients |
To evaluate the performance of Magnetic Resonance enterography (MRE) in the diagnostic work-up of children presenting with obscure gastrointestinal bleeding (OGIB). |
25 patients (mean age 10.8±4.5 years, range 4 months to 16 years) were included. MRE was diagnostic in 76% (19 of 25). The most frequent diagnoses were intestinal polyp (28%) and Meckel's diverticulum (16%). Sensitivity and specificity of MRE were 86% and 100% respectively. There were no reported complications during any of the examinations. |
2 |
| 60. Bocker U, Dinter D, Litterer C, et al. Comparison of magnetic resonance imaging and video capsule enteroscopy in diagnosing small-bowel pathology: localization-dependent diagnostic yield. Scand J Gastroenterol. 45(4):490-500, 2010 Apr. |
Observational-Dx |
46 patients |
To compare the diagnostic utility and yield of video-capsule enteroscopy to that of MRI in patients with suspected or established Crohn's disease (Group I), obscure GI blood loss (Group II), or suspected tumors (Group III). |
In Group I, lesions were found by video-capsule enteroscopy in 9/21 patients and by MRI in 6. In 5 patients, both modalities showed pathology. In Group II, pathological changes were detected in 11/20 patients by video-capsule enteroscopy and in 8 patients by MRI. In 5 cases, pathology was found with both modalities. In Group III, neither modality showed small-bowel pathology. For the patient groups combined, diagnostic yield was 43% with video-capsule enteroscopy and 30% with MRI. The diagnostic yield of video-capsule enteroscopy was superior to that of MRI in the upper small bowel in both Groups I and II. |
3 |
| 61. Wiarda BM, Heine DG, Mensink P, et al. Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding. Endoscopy. 2012;44(7):668-673. |
Observational-Dx |
38 patients |
To compare the diagnostic yield of MR enteroclysis and CE in patients with obscure GI bleeding, using balloon-assisted enteroscopy as the reference standard. |
Over a period of 26 months, 38 patients were included (20 female [53%]; mean age 58 years, range 28–75 years). 4 patients (11%) did not undergo CE due to high grade small-bowel stenosis at MR enteroclysis (n = 3; 8%) or timing issues (n = 1; 3%). CE was nondiagnostic in 1 patient. The reference standard identified abnormal findings in 20 patients (53%). MR enteroclysis had sensitivity, specificity, and positive and negative likelihood ratios of 21%, 100%, infinity, and 0.79, respectively. The corresponding values for CE were 61%, 85%, 4.1, and 0.46. The reference standard and CE did not differ in percent positive findings (P=0.34), but MRE differed significantly from the reference balloon-assisted enteroscopy (P<0.001). CE was superior to MR enteroclysis for detecting abnormalities (P=0.0015). |
2 |
| 62. Tabibian JH, Wong Kee Song LM, Enders FB, Aguet JC, Tabibian N. Technetium-labeled erythrocyte scintigraphy in acute gastrointestinal bleeding. Int J Colorectal Dis. 2013;28(8):1099-1105. |
Observational-Dx |
100 consecutive TRBC scans |
To evaluate the clinical outcomes of the technetium-labeled RBC scan in patients presenting with acute GI bleeding. |
Of the 80 technetium-labeled RBC scans, 29 (36%) were positive and 51 (64%) were negative for bleeding. 8 (10%) were incorrect positive (leading to 5 incorrect operations), 12 (15%) true positive, 9 (11%) unconfirmed positive, 17 (21%) false negative, and 34 (43%) unconfirmed negative. The cause of bleeding was confirmed in 31 cases, of which the scan result was incorrect positive in 2 (7%), true positive in 12 (39%), and false negative in 17 (55%). |
3 |
| 63. Dolezal J, Vizda J, Kopacova M. Single-photon emission computed tomography enhanced Tc-99m-pertechnetate disodium-labelled red blood cell scintigraphy in the localization of small intestine bleeding: a single-centre twelve-year study. Digestion. 2011;84(3):207-211. |
Review/Other-Dx |
26 patients |
The authors present their experience with the detection of bleeding in the small intestine by means of scintigraphy with in vivo-labelled RBCs in the period of 1998-2009. |
A total of 26 patients had a positive scintigraphy with in vivo-labelled RBCs and 14 patients had negative scintigraphy. The final diagnosis was confirmed in 20/26 patients with a positive scintigraphy by push enteroscopy (6/20), intraoperative enteroscopy (7/20), surgery (4/20), duodenoscopy (1/20), double-balloon enteroscopy (1/20) and X-ray angiography (1/20). The correct location of the bleeding site was identified by RBC scintigraphy in 15/20 (75%) patients with the confirmed source. The locations of the bleeding site identified by scintigraphy and enteroscopy (push, intraoperative) and surgical investigations were highly correlated in patients with a positive scintigraphy within the first 3 hours. 11/20 correctly localized studies and none of the incorrectly localized studies were positive in the dynamic phase of imaging. In 5 patients (all erroneously localized), scintigraphy was positive only at a period longer than 18 hours. |
4 |
| 64. Otomi Y, Otsuka H, Terazawa K, et al. The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: a retrospective study. BMC Gastroenterol. 18(1):183, 2018 Dec 10. |
Observational-Dx |
20 patients |
To retrospectively assess the capabilities of SPECT/CT in the diagnosis of gastrointestinal bleeding by a comparison with planar imaging alone as well as planar and SPECT. |
The diagnostic ability of the three imaging methods in detecting the presence of gastrointestinal bleeding was as follows. Planar imaging showed 100% sensitivity (3/3), 100% specificity (2/2), and 100% accuracy (5/5). Planar + SPECT imaging showed 85.7% sensitivity (6/7), 100% specificity (2/2), and 88.9% accuracy (8/9). Planar + SPECT/CT imaging showed 100% sensitivity (6/6), 100% specificity (1/1), and 100% accuracy (7/7). The diagnostic ability of the three modalities in detecting the site of bleeding was as follows: planar, 33. 3% (1/3); planar + SPECT, 71.4% (5/7); and planar + SPECT/CT, 100% (6/6). |
3 |
| 65. Park S, Jeong B, Shin JH, Jang EH, Hwang JH, Kim JH. Transarterial embolisation for gastroduodenal bleeding following endoscopic resection. Br J Radiol. 94(1122):20210062, 2021 Jun 01. |
Observational-Tx |
15 consecutive patients who underwent TAE for gastroduodenal bleeding after endoscopic resection |
To report the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. |
Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. |
3 |
| 66. Hsia CC, Wang CY, Huang JF, et al. Diagnostic Accuracy of Computed Tomography for the Prediction of the Need for Laparotomy for Traumatic Hollow Viscus Injury: Systematic Review and Meta-Analysis. J Pers Med 2021;11. |
Meta-analysis |
16 studies (12,514 patients) |
To analyze how precise and reliable CT is as a tool for the assessment of traumatic hollow viscus injury (THVI). |
Sixteen studies enrolling 12,514 patients were eligible for the final analysis. The summary sensitivity and specificity of CT for the diagnosis of THVI were 0.678 (95% CI: 0.501-0.809) and 0.969 (95% CI: 0.920-0.989), respectively. The summary false positive rate was 0.031 (95% CI 0.011-0.071). |
Inadequate |
| 67. Murugesan SD, Sathyanesan J, Lakshmanan A, et al. Massive hemobilia: a diagnostic and therapeutic challenge. World J Surg. 38(7):1755-62, 2014 Jul. |
Review/Other-Dx |
20 patients |
To evaluate the challenges involved in the diagnosis and management of massive hemobilia. |
Causes of hemobilia were blunt liver trauma (n = 9), hepatobiliary intervention (n = 4), post-laparoscopic cholecystectomy hepatic artery pseudoaneurysm (n = 3), hepatobiliary tumors (n = 3), and vascular malformation (n = 1). Melena, abdominal pain, hematemesis, and jaundice were the leading symptoms. All patients had undergone upper GI endoscopy, abdominal ultrasound, and computerized tomography of the abdomen. An angiogram and therapeutic embolization were done in 12 patients and was successful in nine but failed in three, requiring surgery. Surgical procedures performed were right hepatectomy (n = 4), extended right hepatectomy (n = 1), segmentectomy (n = 1), extended cholecystectomy (n = 1), repair of the pseudoaneurysm (n = 3), and right hepatic artery ligation (n = 1). |
4 |
| 68. Rebibo L, Fuks D, Blot C, et al. Gastrointestinal bleeding complication of gastric fistula after sleeve gastrectomy: consider pseudoaneurysms. Surg Endosc 2013;27:2849-55. |
Review/Other-Dx |
40 patients |
To describe our experience of GI bleeding of gastric fistula after sleeve gastrectomy, and suggest a procedure for the standardized management of this life-threatening complication. |
Forty patients were treated for post-LSG GF in our institution, 18 of whom (45 %) had been referred by tertiary centers. Four patients presented UGIB (10 %): two had undergone primary LSG, one had undergone simultaneous gastric band removal and LSG, and one had undergone repeat LSG. The median time interval between GF and UGIB was 15 days. The four cases of UGIB included three pseudoaneurysms (75 %, with two affecting the left gastric artery and one affecting the upper pole of the splenic artery) and one case of bleeding related to stent-induced gastric ulceration. Computed tomography enabled diagnosis of the pseudoaneurysm in all cases. Two of the four patients (50 %) were treated with selective embolization during arteriography, and two (50 %) were treated surgically with arterial ligation. One of the surgically treated patients died during follow-up. |
4 |
| 69. Wu CH, Wang LJ, Wong YC, et al. Contrast-enhanced multiphasic computed tomography for identifying life-threatening mesenteric hemorrhage and transmural bowel injuries. J Trauma. 71(3):543-8, 2011 Sep. |
Observational-Dx |
106 patients |
To investigate whether findings on multiphasic computed tomography (CT) can identify life-threatening mesenteric hemorrhage and bowel injuries. IV contrast used in CT. |
Mesenteric contrast extravasation had 73.5 positive likelihood ratio and 75% sensitivity for active mesenteric hemorrhage. Hemorrhage first appeared at arterial phase and portal phase was active and life threatening, different from a contained hemorrhage appeared only at equilibrium phase. For transmural bowel injuries, positive likelihood ratio of full-thickness bowel wall abnormality and extraluminal air was large at 32.5 and 26.9, respectively. However, increased mesenteric fat density and peritoneal fluid had high negative predictive value at 98.9 and 97.8. Mean radiodensity of peritoneal fluid in transmural bowel injuries was significantly lower (30 vs. 44 Hounsfield unit, p = 0.008). |
2 |
| 70. Luo J, Tang W, Wang M, Xiao Y, Tan M, Jiang C. Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding. BMC Gastroenterol. 21(1):49, 2021 Feb 02. |
Review/Other-Dx |
9 patients |
To present a case series of AEFs are presented and the clinical characteristics, diagnosis, and management strategies are summarized. |
A total of nine patients were included in this study, five with primary AEF and four with secondary AEF. Eight of the patients were male, and the median age was 63 years. The fistulas were located in both the small intestine and the colon. All patients presented with gastrointestinal bleeding and pain, followed by weight loss, anorexia, and fever. A typical abdominal triad was found in only two cases. Seven patients experienced complications with preoperative abdominal infections and sepsis, and multiple organ failure occurred in four of these patients. All patients were assessed by computed tomography and five underwent abdominal and/or iliac aorta angiography. Two of these patients showed contrast agent leakage from the abdominal aorta into the intestine. Two cases were diagnosed with AEF by endoscopy before the operation. Eight patients received surgery and six patients survived. |
4 |
| 71. Deijen CL, Smulders YM, Coveliers HME, Wisselink W, Rauwerda JA, Hoksbergen AWJ. The Importance of Early Diagnosis and Treatment of Patients with Aortoenteric Fistulas Presenting with Herald Bleeds. Ann Vasc Surg. 36:28-34, 2016 Oct. |
Review/Other-Dx |
32 patients with 34 fistulas |
Too: (i) analyze the interval between the herald bleed and onset of major GI hemorrhage and/or diagnosis of AEF and (ii) to evaluate the diagnostic roles of endoscopy and computed tomography imaging. |
In 31 of a total of 34 fistula cases, GI bleeding was the presenting symptom. Of these, 17 of 31 presented with herald bleed while 14 of 31 presented with massive GI bleeding. In patients with a herald bleed, median time from first bleeding to diagnosis was 14 (2-137) days. In 5/17 patients, herald bleeding preceded major hemorrhage with a median of 6 (4-92) days before a diagnosis of AEF was made or intervention could be initiated. CT angiography (CTA) showed abnormalities associated with a fistula in 27 (79%) cases, of which in 12 (35%) cases a fistula was actually identified. Esophagogastroduodenoscopy (EGD) demonstrated a fistula in 8 (25%) patients, while 50% of EGDs were completely normal. |
4 |
| 72. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
