title: Role of computed tomography angiography on the management of overt obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  The role of computed tomography angiography (CTA) on the management of acute overt obscure gastrointestinal bleeding (OGIB) remains unclear. We designed a study to evaluate the impact of CTA before enteroscopy for acute overt OGIB.
  
  
  METHODS
  All patients undergoing CTA followed by enteroscopy for acute overt OGIB were enrolled in this retrospective study. Clinical characteristics and diagnosis were compared between patients with positive and negative CTA findings. We evaluated the impact of CTA on subsequent enteroscopy.
  
  
  RESULTS
  From February 2008 to March 2015, 71 patients including 25 patients with positive CTA findings and 46 patients with negative CTA findings, were enrolled. All 25 patients with positive CTA findings were confirmed to have mid GI lesions, a significantly higher proportion than among patients with negative CTA findings (100% vs. 52.2%, respectively; P <0.001). CTA had a higher diagnostic yield for bleeding from tumor origin than from non-tumor origin (80.0% vs. 23.7%, respectively; P <0.001). The diagnostic yield of CTA and enteroscopy was 35.2% and 73.2%, respectively. The lesions could be identified by the initial route of enteroscopy in more patients with positive CTA findings than in those with negative CTA findings (92.0% vs. 47.8%, respectively; P <0.001). Lesions could be identified in seven of the 25 patients (28.0%) with positive CTA findings by using only push enteroscopy instead of single-balloon enteroscopy (SBE), but all 46 patients with negative CTA findings needed SBE for deep small-bowel examination.
  
  
  CONCLUSIONS
  CTA is useful in the diagnosis of acute overt OGIB, especially in patients with bleeding from tumors. In addition, it also can show the precise location of bleeding, and guide subsequent enteroscopic management.
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.|Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan city, Taiwan.
authors.forename: Chao-Ming
authors.initials: CM
authors.lastname: Tseng
authors.affiliation: Department of Radiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan city, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.|Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan city, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.|Division of Gastroenterology, Tainan Municipal Hospital, Tainan City, Taiwan.
authors.forename: Lein-Ray
authors.initials: LR
authors.lastname: Mo
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.|School of Medicine and Big Data Research Centre, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.|Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan city, Taiwan.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*