CTA Abdomen and Pelvis Without and With IV Contrast Besides angiography, CTA abdomen and pelvis without and with IV contrast may become useful when endoscopy shows nonvariceal UGIB without a clear source. As highlighted in previous variants, CTA without and with IV contrast has high accuracy for the detection of GIB. CTA can detect small bowel lesions that may be difficult to see on traditional esophagogastroduodenoscopy but may be better visualized by push enteroscopy [43]. Because CTA can identify a slower bleeding rate than angiography, CTA has been demonstrated to have significantly higher detection of active bleeding as well as localization of the culprit lesion [46]. CTA can also show Dieulafoy lesions that have a very high mortality rate [47,48]. Nonvariceal Upper Gastrointestinal Bleeding CTA Abdomen With IV Contrast There is no significant literature supporting the use of CTA abdomen with IV contrast. CTA Abdomen Without and With IV Contrast There is no significant literature supporting the use of CTA abdomen without and with IV contrast, because lesions not clearly seen on endoscopy may be localized to small bowel, which often requires inclusion of the pelvis. CTA Chest With IV Contrast There is no significant literature supporting the use of CTA chest with IV contrast. CTA Chest Without and With IV Contrast There is no significant literature supporting the use of CTA chest without and with IV contrast. Fluoroscopy Upper GI Series Barium or iodine upper GI series has no role in the diagnosis of acute UGIB. MR Enterography There is no significant literature supporting the use of MR enterography as an imaging test for UGIB, which is confirmed on endoscopy but without a clear source. RBC Scan Abdomen and Pelvis Because CTA evaluation is a well-recognized next step in the management of UGIB if endoscopy confirms bleeding without identification of a source, there is no significant literature outlining the use of nuclear medicine studies in this clinical context.
Nonvariceal Upper Gastrointestinal Bleeding. CTA Abdomen and Pelvis Without and With IV Contrast Besides angiography, CTA abdomen and pelvis without and with IV contrast may become useful when endoscopy shows nonvariceal UGIB without a clear source. As highlighted in previous variants, CTA without and with IV contrast has high accuracy for the detection of GIB. CTA can detect small bowel lesions that may be difficult to see on traditional esophagogastroduodenoscopy but may be better visualized by push enteroscopy [43]. Because CTA can identify a slower bleeding rate than angiography, CTA has been demonstrated to have significantly higher detection of active bleeding as well as localization of the culprit lesion [46]. CTA can also show Dieulafoy lesions that have a very high mortality rate [47,48]. Nonvariceal Upper Gastrointestinal Bleeding CTA Abdomen With IV Contrast There is no significant literature supporting the use of CTA abdomen with IV contrast. CTA Abdomen Without and With IV Contrast There is no significant literature supporting the use of CTA abdomen without and with IV contrast, because lesions not clearly seen on endoscopy may be localized to small bowel, which often requires inclusion of the pelvis. CTA Chest With IV Contrast There is no significant literature supporting the use of CTA chest with IV contrast. CTA Chest Without and With IV Contrast There is no significant literature supporting the use of CTA chest without and with IV contrast. Fluoroscopy Upper GI Series Barium or iodine upper GI series has no role in the diagnosis of acute UGIB. MR Enterography There is no significant literature supporting the use of MR enterography as an imaging test for UGIB, which is confirmed on endoscopy but without a clear source. RBC Scan Abdomen and Pelvis Because CTA evaluation is a well-recognized next step in the management of UGIB if endoscopy confirms bleeding without identification of a source, there is no significant literature outlining the use of nuclear medicine studies in this clinical context.