title: 64-section multiphase CT enterography as a diagnostic tool in the evaluation of obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  Small bowel follow through (SBFT) and enteroclysis have low sensitivity in picking up lesions in obscure gastrointestinal bleed (OGIB). Computed tomographic enterography (CT-EG), performed with 64-slice multiphase CT system by using large volumes of ingested neutral enteric contrast material, has high spatial and temporal resolution in visualization of the small bowel wall and lumen. The role of 64-slice multiphase CT-EG in the evaluation of OGIB is still evolving, and data on this role are scarce. We evaluated the efficacy of 64-slice multiphase CT-EG using polyethylene glycol (PEG) electrolyte solution as neutral contrast in patients of OGIB.
  
  
  METHODS
  CT-EG was performed with 64-slice multiphase CT system using large volume (2,000 mL) of PEG electrolyte solution as oral contrast in patients of OGIB.
  
  
  RESULTS
  Thirty-five patients (21 men, age 41.4 [13.5] y, range 19-70 year) with OGIB underwent CT-EG; 20 patients had overt OGIB whereas 15 patients had occult OGIB. Among 15 patients with occult OGIB, 10 patients had iron deficiency anemia (IDA) with fecal occult blood test (FOBT) positive and 5 had IDA with FOBT negative. Thirty-two patients (92 %) completed the procedure successfully. The total time taken for the ingestion of 2,000 mL of PEG electrolyte solution was median 64 (range 60-78) minutes. Adequate luminal distension of small bowel was seen in 29 (90.6 %) patients for successful interpretation of radiological images. Fifteen of 32 (46.9 %) patients had positive findings on CT-EG; 12 of them underwent exploratory laparotomy. The surgical findings were in conformity with CT-EG findings in all patients, which included gastrointestinal stromal tumors (GIST; n = 6), carcinoid (1), Meckel's diverticulum (1), small bowel adenocarcinoma (2) and jejunal vascular malformation (2).
  
  
  CONCLUSIONS
  64-slice multiphase CT-EG is a useful investigation in the evaluation of both occult and overt OGIB.
authors.affiliation: Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190 011, India. showkatzargar6@gmail.com
authors.forename: Jaswinder Singh
authors.initials: JS
authors.lastname: Sodhi
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zargar
authors.forename: Wasim
authors.initials: W
authors.lastname: Rashid
authors.forename: Feroz
authors.initials: F
authors.lastname: Shaheen
authors.forename: Manjeet
authors.initials: M
authors.lastname: Singh
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.forename: Sadaf
authors.initials: S
authors.lastname: Ali
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Khan
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Yattoo
authors.forename: Altaf
authors.initials: A
authors.lastname: Shah
authors.forename: Ghulam Mohamad
authors.initials: GM
authors.lastname: Gulzar
authors.forename: Mushtaq Ahmed
authors.initials: MA
authors.lastname: Khan
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011092:Polyethylene Glycols; D055815:Young Adult
chemical_list: D003287:Contrast Media; D011092:Polyethylene Glycols