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Journal of Gastroenterology

, Volume 50, Issue 12, pp 1162–1172 | Cite as

Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopy

  • Naoyoshi NagataEmail author
  • Ryota Niikura
  • Tomonori Aoki
  • Shiori Moriyasu
  • Toshiyuki Sakurai
  • Takuro Shimbo
  • Masafumi Shinozaki
  • Katsunori Sekine
  • Hidetaka Okubo
  • Kazuhiro Watanabe
  • Chizu Yokoi
  • Mikio Yanase
  • Junichi Akiyama
  • Naomi Uemura
Original Article—Alimentary Tract

Abstract

Background

The clinical significance of performing computed tomography (CT) for acute lower gastrointestinal bleeding (LGIB) remains unknown. This study aimed to evaluate the role of urgent CT in acute LGIB settings.

Methods

The cohort comprised 223 patients emergently hospitalized for LGIB who underwent early colonoscopy within 24 h of arriving at the hospital, including 126 who underwent CT within 3 h of arrival. We compared the bleeding source rate between two strategies: early colonoscopy following urgent CT or early colonoscopy alone.

Results

No significant differences in age, sex, comorbidities, vital signs, or laboratory data were observed between the strategies. The detection rate was higher with colonoscopy following CT for vascular lesions (35.7 vs. 20.6 %, p = 0.01), leading to more endoscopic therapies (34.9 vs. 13.4 %, p < 0.01). Of the 126 who underwent colonoscopy following CT, 26 (20.6 %) had extravasation and 34 (27.0 %) had nonvascular findings. The sensitivity and specificity of CT extravasation and nonvascular findings for predicting vascular lesions and inflammation or tumors were 37.8 and 88.9 and 81.3 and 80.9 %, respectively. A high κ agreement (0.83, p < 0.01) for active bleeding locations was found between CT and subsequent colonoscopy. There were no cases of contrast-induced nephropathy after 1 week of CT.

Conclusions

Urgent CT before colonoscopy had about 15 % additional value for detecting vascular lesion compared to colonoscopy alone and thus enabled subsequent endoscopic therapies. Contrast-enhanced CT in acute LGIB settings was safe and correctly identified the presence and location of active bleeding, as well as severe inflammation or tumor stenosis, facilitating decision making.

Keywords

Multidetector computed tomography (MDCT) angiography Urgent colonoscopy Acute lower gastrointestinal hemorrhage Colonic diverticular bleeding 

Notes

Acknowledgments

We thank the clinical research coordinators Ms. Hisae Kawashiro, Sawako Iijima, Yoko Tanigawa, Aiko Gotannda, and Yaeko Sawada for help with data collection. This study was partly supported by a grant for research and development from the National Center for Global Health and Medicine (26A-201).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Naoyoshi Nagata
    • 1
    Email author
  • Ryota Niikura
    • 1
  • Tomonori Aoki
    • 1
  • Shiori Moriyasu
    • 1
  • Toshiyuki Sakurai
    • 1
  • Takuro Shimbo
    • 2
  • Masafumi Shinozaki
    • 3
  • Katsunori Sekine
    • 1
  • Hidetaka Okubo
    • 1
  • Kazuhiro Watanabe
    • 1
  • Chizu Yokoi
    • 1
  • Mikio Yanase
    • 1
  • Junichi Akiyama
    • 1
  • Naomi Uemura
    • 4
  1. 1.Department of Gastroenterology and HepatologyNational Center for Global Health and Medicine (NCGM)TokyoJapan
  2. 2.Department of Clinical Research and InformaticsInternational Clinical Research Center, Research Institute, National Center for Global Health and MedicineTokyoJapan
  3. 3.Department of Diagnostic RadiologyNational Center for Global Health and MedicineTokyoJapan
  4. 4.Department of Gastroenterology and HepatologyNational Center for Global Health and Medicine, Kohnodai HospitalChibaJapan

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