Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey

Jeff Lynn Fidler, Flavius F. Guglielmo, Olga R. Brook, Lisa L. Strate, David H. Bruining, Avneesh Gupta, Brian C. Allen, Mark A. Anderson, Michael Wells, Vijay Ramalingam, Martin L. Gunn, David J. Grand, Michael S. Gee, Alvaro Huete, Ashish Khandalwal, Farnoosh Sokhandon, Seong Ho Park, Don C. Yoo, Jorge A. Soto

Research output: Contribution to journalArticlepeer-review

Abstract

Abstract: Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 (40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable (n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding. Graphic abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StateAccepted/In press - 2021

Keywords

  • Angiography
  • Capsule endoscopy
  • Colonoscopy
  • Computed tomography angiography
  • Gastrointestinal
  • Hemorrhage
  • Multidetector computed tomography

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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