Korean J Gastroenterol.  2016 Apr;67(4):198-206. 10.4166/kjg.2016.67.4.198.

Clinical Efficacy of Dynamic Contrast-enhanced Multidetector-row Computed Tomography in Patients with Obscure Gastrointestinal Bleeding

Affiliations
  • 1Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea. songhj@jejunu.ac.kr
  • 2Department of Radiology, Jeju National University School of Medicine, Jeju, Korea.

Abstract

BACKGROUND/AIMS
Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients.
METHODS
We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed.
RESULTS
The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010).
CONCLUSIONS
Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB.

Keyword

Gastrointestinal hemorrhage; Multidetector computed tomography

MeSH Terms

Adult
Aged
Aged, 80 and over
Colonoscopy
Female
Gastrointestinal Hemorrhage/*diagnostic imaging
Humans
Male
Melena/etiology
Middle Aged
*Multidetector Computed Tomography
Recurrence
Retrospective Studies

Figure

  • Fig. 1. Patient enrollment. Data on a total of 45 patients were collected retrospectively. DCE-MDCT, dynamic contrast-enhanced multidetector-row CT; GI, gastrointestinal; EGD, esophagogastroduodenoscopy; CFS, colonoscopy.

  • Fig. 2. Dynamic contrast-enhanced multidetector-row CT image of a 61-year-old female with recurrent hematochezia. (A) Intraluminal contrast extravastion was noted in ileal loop (arrow). (B) Subsequent angiography revealed active contrast extravasation from ileal artery distal branch (arrow). (C) Successful arterial embolization was done (arrow).

  • Fig. 3. Dynamic contrast-enhanced multidetector-row CT and capsule endoscopic image of a 73-year-old male with hematochezia. (A) Hyper-attenuating blood clot was visualized in ascending colon (asterisk). (B) Active ulcer (arrow) with fresh and old blood clot (arrowhead) was seen on the middle jejunum. Conservative management was performed and he did not experience recurrent bleeding after discontinuation of aspirin.

  • Fig. 4. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) and capsule endoscopic image of a 17-year-old male with recurrent iron deficiency anemia. (A) A small bowel hemangioma (arrow) with heterogeneous enhancement and small phleboliths were noted in the left side of pelvic cavity on DCE-MDCT. (B) A large pedunculated mass (arrows) with purplish surface was noted in the middle jejunum on capsule endoscopy. Surgical resection of the small bowel hemangioma was performed.

  • Fig. 5. (A) Cumulative rebleeding rates of patients. (B) Cumulative rebleeding rates according to dynamic contrast-enhanced multidetector-row CT results.


Cited by  1 articles

The Role of Dynamic Contrast-enhanced Multidetector-row Computed Tomography in Diagnosis of Obscure Gastrointestinal Bleeding
Jee Hyun Kim, Jong Pil Im
Korean J Gastroenterol. 2016;67(4):165-167.    doi: 10.4166/kjg.2016.67.4.165.


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