Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding.
BACKGROUND
Upper and lower acute gastrointestinal bleeding (AGIB) is associated with high rates of mortality and morbidity. The latest computerized tomography (CT) imaging techniques play an important role in the treatment of this pathology.


METHODS
Twenty-nine patients with severe AGIB (11 upper, 18 lower), all hemodynamically stable, underwent endoscopy followed by a multi-detector row CT (MDCT) scan. Endoscopic and MDCT accuracy for the anatomical localization and etiology of AGIB was assessed, the diagnosis being considered correct when the two procedures were concordant or when the diagnosis was confirmed by angiographic, surgical, or post-mortem findings.


RESULTS
The sensitivity in identifying the site and etiology of bleeding was, respectively, 100% and 90.9% for the MDCT scan, compared with 72.7% and 54.5% for endoscopy in upper AGIB, and 100% and 88.2% for the MDCT scan, compared with 52.9% and 52.9% for endoscopy, in lower AGIB.


CONCLUSIONS
Considering the advantages of MDCT over endoscopy, we propose a new diagnostic algorithm for AGIB.
Frattaroli
Fabrizio M
FM
Department of Surgery "P.Stefanini", "Policlinico Umberto I" Hospital, "Sapienza" University of Rome, Viale del Policlinico, 155 00161, Rome, Italy. fabrizio.frattaroli@uniroma1.it
Casciani
Emanuele
E
Spoletini
Domenico
D
Polettini
Elisabetta
E
Nunziale
Aldo
A
Bertini
Luca
L
Vestri
Annarita
A
Gualdi
Gianfranco
G
Pappalardo
Giuseppe
G
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055815:Young Adult