Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?

Details

Ressource 1Download: s13017-016-0112-3.pdf (716.21 [Ko])
State: Public
Version: Final published version
Serval ID
serval:BIB_B2779C57BB83
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?
Journal
World journal of emergency surgery
Author(s)
Clerc D., Grass F., Schäfer M., Denys A., Demartines N., Hübner M.
ISSN
1749-7922 (Print)
ISSN-L
1749-7922
Publication state
Published
Issued date
2017
Peer-reviewed
Oui
Volume
12
Pages
1
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Lower endoscopy (LE) is the standard diagnostic modality for lower gastrointestinal bleeding (LGIB). Conversely, computed tomographic angiography (CTA) offers an immediate non-invasive diagnosis visualizing the entire gastrointestinal tract. The aim of this study was to compare these 2 modalities with regards to diagnostic value and bleeding control.
Tertiary center retrospective analysis of consecutive patients admitted for LGIB between 2006 and 2012. Comparison of patients with LE <i>vs.</i> CTA as first exam, respectively, with emphasis on diagnostic accuracy and bleeding control.
Final analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR = 8.2) <i>vs.</i> 22 (IQR = 36.9) hours, <i>P</i>  < 0.001). Active bleeding was identified in 31% with CTA <i>vs.</i> 15% with LE ( <i>P</i>  = 0.031); a non-actively bleeding source was found by CTA and LE in 22 <i>vs.</i> 31%, respectively ( <i>P</i>  = 0.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery.
Post-interventional LGIB was effectively addressed by LE. For other causes of LGIB, CTA was efficient, and more available than colonoscopy. Treatment was conservative for most patients. In case of active bleeding, CTA could localize the bleeding source and predict the need for surgery.
Keywords
Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Cohort Studies, Colonoscopy/adverse effects, Colonoscopy/methods, Colonoscopy/standards, Computed Tomography Angiography/adverse effects, Computed Tomography Angiography/methods, Computed Tomography Angiography/standards, Female, Gastrointestinal Hemorrhage/diagnosis, Humans, Male, Middle Aged, Retrospective Studies, Colonoscopy, Computed tomographic angiography, Endoscopy, Gastrointestinal hemorrhage
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2017 19:23
Last modification date
20/08/2019 16:21
Usage data