Upper gastrointestinal bleeding other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Other Imaging Findings

In cases where the source of bleeding is unidentified after upper endoscopy, the utilization of subsequent diagnostic modalities depends upon the hemodynamic stability of the patient. Other diagnostic studies include:

• CT angiography
• Catheter angiography
• Radionuclide imaging

	CT angiography	Catheter angiography	Radionuclide imaging
Bleeding at rates detection	At least 0.5 mL/min	0.5 to 1.5 mL/min	0.1 mL/min
Indications	Hemodynamically stable Endoscopy undiagnostic	Endoscopy not feasible due to severe bleeding with hemodynamic instability Persistent or recurrent GI bleeding Non-diagnostic upper endoscopy
Advantages	Minimally invasive  Demonstrate neoplasms or vascular malformations Can provide evidence of recent bleeding	Diagnostic and therapeutic Allows for infusion of vasoconstrictive drugs and/or embolization. Does not require bowel preparation.	Most sensitive imaging modality for GI bleeding More commonly utilized for investigation of patients with obscure, intermittent bleeding
Disadvantages	Lacks therapeutic capability Risk of contrast induced nephropathy in patients with renal impairment and contrast allergy	Access-site hematoma or pseudoaneurysm Arterial dissection Spasm, bowel ischemia Contrast-induced nephropathy or allergic reaction	Poor anatomic localization of the bleeding site Unable to diagnose the pathological cause of GI bleeding