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Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit

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Abstract

Background

Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking.

Aim

The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding.

Methods

Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3 h) or following (< 3 h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards.

Results

A total of 68 patients (38 men, median age 69 years [range 25–96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5–87.3), 40% (95% CI: 5.3–85.3), and 75% (95% CI: 63.0–84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2–97.5) and 79% (95% CI: 66.8–88.3), respectively.

Conclusion

Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.

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Data availability

This study did not report any data.

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Acknowledgements

We are grateful to Velia De Magistris for English editing.

Author information

Author notes

  1. Marco Di Serafino and Alberto Martino have contributed equally to this work and are equal first authors.

  2. Luigia Romano and Giovanni Lombardi are equal the last authors.

Authors and Affiliations

  1. Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy

    Marco Di Serafino, Roberto Ronza & Luigia Romano

  2. Department of Gastroenterology and Digestive Endoscopy, “Antonio Cardarelli” Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy

    Alberto Martino, Francesco Manguso, Francesco Paolo Zito, Luigi Orsini & Giovanni Lombardi

  3. Department of Interventional Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy

    Francesco Giurazza & Raffaella Niola

  4. Department of Clinical Medicine and Surgery, Gastroenterology and Hepatology Unit, University of Naples “Federico II”, Naples, Italy

    Luca Pignata

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Contributions

Martino A, Manguso F and Di Serafino M designed research and wrote, edited and finalized the text; Martino A, Zito FP, Giurazza F and Pignata L reviewed the Institutional electronic databases; Di Serafino M and Ronza R reviewed the MDCTA images; Martino A, Giurazza F and Pignata L performed the literature search; Martino A and Manguso F analyzed the data; Manguso F performed the statistical analysis; Orsini L, Niola R, Romano L and Lombardi G reviewed the paper for important intellectual content.

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Correspondence to Marco Di Serafino or Alberto Martino.

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Di Serafino, M., Martino, A., Manguso, F. et al. Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04208-9

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