Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding
Background and aims: Computed tomography angiography (CTA) is the radiologic test for acute gastrointestinal bleeding (GIB). We aimed to (1) identify the clinical factors associated with (a) positive CTA findings, (b) positive esophagogastroduodenoscopy (EGD) findings after a negative CTA, and (2) c...
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KeAi Communications Co., Ltd.
2025-04-01
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| Series: | Gastroenterology & Endoscopy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S294975232500010X |
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| author | Joseph Atarere Thilini Delungahawatta Boniface Mensah Ramya Vasireddy Ted O. Akhiwu Yakubu Bene-Alhasan Sarah Rimm Jose Mari Parungao Dana Sloane Christopher Haas David Weisman Haider Naqvi |
| author_facet | Joseph Atarere Thilini Delungahawatta Boniface Mensah Ramya Vasireddy Ted O. Akhiwu Yakubu Bene-Alhasan Sarah Rimm Jose Mari Parungao Dana Sloane Christopher Haas David Weisman Haider Naqvi |
| author_sort | Joseph Atarere |
| collection | DOAJ |
| description | Background and aims: Computed tomography angiography (CTA) is the radiologic test for acute gastrointestinal bleeding (GIB). We aimed to (1) identify the clinical factors associated with (a) positive CTA findings, (b) positive esophagogastroduodenoscopy (EGD) findings after a negative CTA, and (2) compare bleeding severity on EGD by CTA findings. Methods: Using data from a retrospective cohort of patients, we examined the factors associated with positive CTA findings and those associated with bleeding on EGD after a negative CTA. We examined the severity of upper GIB on EGD by findings on CTA and compared bleeding severity with the Glasgow Blatchford Score (GBS). We also evaluated the factors associated with high-grade bleeding lesions on EGD. Results: A total of 1677 patients were included in this study, of which 229 (13.7 %) had positive CTA findings. A history of GIB, hematochezia on presentation and any length of stay in the ICU were associated with positive CTA findings. Among patients with negative CTA results, hematemesis on presentation [OR 2.94; 95 % CI (1.53, 5.64)] and high-risk GBS [OR 5.19; 95 % CI (2.02, 13.35)] were associated with finding upper GIB on EGD. ICU admission for 4+ days was associated with higher-grade bleeding lesions. Those with positive CTA findings had a higher proportion of Forrest 1 lesions (10.8 % vs 3.7 %). Conclusion: Our findings support a low threshold for EGD among patients with extended ICU stays (4+ days) even after a negative CTA. The GBS, validated for risk stratification in upper GIB, remains a useful predictive tool even in the context of a negative CTA. |
| format | Article |
| id | doaj-art-4fa88a97379c4ce3b76b2d87faa989d4 |
| institution | OA Journals |
| issn | 2949-7523 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | KeAi Communications Co., Ltd. |
| record_format | Article |
| series | Gastroenterology & Endoscopy |
| spelling | doaj-art-4fa88a97379c4ce3b76b2d87faa989d42025-08-20T02:25:35ZengKeAi Communications Co., Ltd.Gastroenterology & Endoscopy2949-75232025-04-013211612410.1016/j.gande.2025.03.004Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleedingJoseph Atarere0Thilini Delungahawatta1Boniface Mensah2Ramya Vasireddy3Ted O. Akhiwu4Yakubu Bene-Alhasan5Sarah Rimm6Jose Mari Parungao7Dana Sloane8Christopher Haas9David Weisman10Haider Naqvi11Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA; Corresponding author. 201 E University Pkwy, Baltimore, MD, 21218, USA.Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Franklin Square Medical Center, Rossville, MD, USADepartment of Gastroenterology, MedStar Franklin Square Medical Center, Rossville, MD, USADepartment of Gastroenterology, MedStar Franklin Square Medical Center, Rossville, MD, USADepartment of Medicine, MedStar Franklin Square Medical Center, Rossville, MD, USADepartment of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USADepartment of Medicine, MedStar Franklin Square Medical Center, Rossville, MD, USABackground and aims: Computed tomography angiography (CTA) is the radiologic test for acute gastrointestinal bleeding (GIB). We aimed to (1) identify the clinical factors associated with (a) positive CTA findings, (b) positive esophagogastroduodenoscopy (EGD) findings after a negative CTA, and (2) compare bleeding severity on EGD by CTA findings. Methods: Using data from a retrospective cohort of patients, we examined the factors associated with positive CTA findings and those associated with bleeding on EGD after a negative CTA. We examined the severity of upper GIB on EGD by findings on CTA and compared bleeding severity with the Glasgow Blatchford Score (GBS). We also evaluated the factors associated with high-grade bleeding lesions on EGD. Results: A total of 1677 patients were included in this study, of which 229 (13.7 %) had positive CTA findings. A history of GIB, hematochezia on presentation and any length of stay in the ICU were associated with positive CTA findings. Among patients with negative CTA results, hematemesis on presentation [OR 2.94; 95 % CI (1.53, 5.64)] and high-risk GBS [OR 5.19; 95 % CI (2.02, 13.35)] were associated with finding upper GIB on EGD. ICU admission for 4+ days was associated with higher-grade bleeding lesions. Those with positive CTA findings had a higher proportion of Forrest 1 lesions (10.8 % vs 3.7 %). Conclusion: Our findings support a low threshold for EGD among patients with extended ICU stays (4+ days) even after a negative CTA. The GBS, validated for risk stratification in upper GIB, remains a useful predictive tool even in the context of a negative CTA.http://www.sciencedirect.com/science/article/pii/S294975232500010XComputed tomography angiographyGastrointestinal bleedForrest classificationEsophagogastroduodenoscopyGlasgow blatchford bleeding score |
| spellingShingle | Joseph Atarere Thilini Delungahawatta Boniface Mensah Ramya Vasireddy Ted O. Akhiwu Yakubu Bene-Alhasan Sarah Rimm Jose Mari Parungao Dana Sloane Christopher Haas David Weisman Haider Naqvi Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding Gastroenterology & Endoscopy Computed tomography angiography Gastrointestinal bleed Forrest classification Esophagogastroduodenoscopy Glasgow blatchford bleeding score |
| title | Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| title_full | Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| title_fullStr | Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| title_full_unstemmed | Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| title_short | Diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| title_sort | diagnostic efficacy of computed tomography angiography for acute gastrointestinal bleeding |
| topic | Computed tomography angiography Gastrointestinal bleed Forrest classification Esophagogastroduodenoscopy Glasgow blatchford bleeding score |
| url | http://www.sciencedirect.com/science/article/pii/S294975232500010X |
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