Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy.
Department of Gastroenterology and Digestive Endoscopy, "Antonio Cardarelli" Hospital, Antonio Cardarelli St 9, 80131, Naples, Italy.
Abdom Radiol (NY). 2024 May;49(5):1385-1396. doi: 10.1007/s00261-024-04208-9. Epub 2024 Mar 4.
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.
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.
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.
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.
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.
非静脉曲张性上消化道出血是一种常见的胃肠急症，与较高的发病率和死亡率相关。上消化道内镜检查目前被推荐作为诊断和治疗的金标准。尽管多层螺旋 CT 血管造影术在急性非静脉曲张性上消化道出血的诊断中一直发挥着有限的作用，但它作为一种有前途的工具，在非静脉曲张性上消化道出血的诊断中越来越受到关注，特别是在严重情况下。然而，迄今为止，关于多层螺旋 CT 血管造影术在非静脉曲张性上消化道出血诊断中的作用的证据仍然缺乏。
本研究的目的是回顾性研究在任何诊断方式之前或在紧急上消化道内镜检查之后进行的紧急多层螺旋 CT 血管造影术，以确定严重非静脉曲张性上消化道出血的状态、部位和潜在病因。
为了识别严重的急性非静脉曲张性上消化道出血患者，我们对 2019 年 12 月至 2022 年 10 月期间入住我们出血科并接受紧急多层螺旋 CT 血管造影术（<3 小时）或内镜检查后（<3 小时）的患者的机构数据库进行了回顾。本研究的目的是评估多层螺旋 CT 血管造影术在检测严重非静脉曲张性上消化道出血的状态、部位和病因方面的诊断性能，将内镜、数字减影血管造影术、手术、病理或它们的组合作为参考标准。
共纳入 68 例患者（38 例男性，中位年龄 69 岁[范围 25-96 岁]）。多层螺旋 CT 血管造影术对出血状态的总体敏感性、特异性和准确性分别为 77.8%（95%CI：65.5-87.3）、40%（95%CI：5.3-85.3）和 75%（95%CI：63.0-84.7）。最后，多层螺旋 CT 血管造影术对识别出血部位和出血病因的总体敏感性分别为 92.4%（95%CI：83.2-97.5）和 79%（95%CI：66.8-88.3）。
尽管上消化道内镜检查是大多数非静脉曲张性上消化道出血病例的主要诊断和治疗方法，但多层螺旋 CT 血管造影术似乎是一种可行且有效的方法，可用于检测严重急性非静脉曲张性上消化道出血的部位、状态和病因。它可能在非静脉曲张性上消化道出血的管理中发挥关键作用，特别是对那些临床上严重和/或继发于罕见和极罕见来源的病例，有效地指导治疗的时机和类型。然而，需要进一步的大型前瞻性研究来阐明多层螺旋 CT 血管造影术在急性非静脉曲张性上消化道出血诊断过程中的作用。
