CT血管造影与内镜检查在急性胃肠道出血患者中的诊断效用比较
Diagnostic utility of CT angiography compared with endoscopy in patients with acute GI hemorrhage.
作者信息
Erno Jason, Gregoski Mathew J, Rockey Don C
机构信息
Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health, Medical University of South Carolina, Charleston, South Carolina, USA.
出版信息
Gastrointest Endosc. 2024 Feb;99(2):257-261.e5. doi: 10.1016/j.gie.2023.10.002. Epub 2023 Oct 6.
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.
背景与目的
由于CT血管造影（CTA）具有微创性，已成为用于急性胃肠道出血检查的一种有吸引力的诊断工具。
方法
本研究对接受CTA检查的急性胃肠道出血患者进行了检测。
结果
CTA是177例患者的初始诊断检查，分别在16例和27例患者中发现上消化道和下消化道出血病变。在103例CTA初始结果为阴性的患者中，78例接受了内镜检查（32例进行了食管胃十二指肠镜检查，46例进行了结肠镜检查/乙状结肠镜检查），其中52例（67%）发现了出血病变，包括23例需要治疗的高危出血病变。消化性溃疡病和憩室出血是最常见的出血病变。以内镜检查作为标准对照，CTA检测胃肠道出血源的敏感性为20%。
结论
CTA在识别胃肠道出血源或病变方面的敏感性非常低，这表明CTA不应作为初始诊断检查。
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