Diagnostic utility of CT angiography compared with endoscopy in patients with acute GI hemorrhage

Background and aims: Because it is minimally invasive, CT angiography (CTA) has emerged as an attractive diagnostic tool for investigation of acute GI hemorrhage.

Methods: This study examined patients with acute GI bleeding who underwent CTA.

Results: CTA was the initial diagnostic examination in 177 patients, identifying upper and lower GI bleeding lesions in 16 and 27 patients, respectively. In 103 patients with an initial negative CTA, 78 had endoscopy (32 EGD and 46 colonoscopy/flexible sigmoidoscopy), of whom 52 (67%) had a bleeding lesion identified, including 23 with a high-risk bleeding lesion requiring therapy. Peptic ulcer disease and diverticular bleeding were the most commonly identified bleeding lesions. With endoscopy as a criterion standard, the sensitivity of CTA for the detection of a source of GI bleeding was 20%.

Conclusions: CTA has very poor sensitivity for identification of a GI bleeding source or lesion, suggesting that CTA should not be used as an initial diagnostic test.