However, the use of these virtual unenhanced images in place of true unenhanced images is still limited to certain sites and remains a user-specific preference. So, they are not discussed in this document. CTA Abdomen and Pelvis Without and With IV Contrast Although there is no literature to discuss the difference between diagnostic accuracy of CTA abdomen and pelvis without and with IV contrast versus CTA abdomen without and with IV contrast or CTA chest without and with IV contrast, in patients with a known source of bleeding that cannot be controlled endoscopically, the imaging should be tailored to include the site of the bleeding. Overall, CTA has good accuracy for the detection of tumor bleeding, vascular malformations, or diverticular bleeding [7,42,43]. 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 comparing the use of CTA abdomen and pelvis without and with IV contrast for UGIB. However, as highlighted earlier in this document, if the known source of bleeding if localized to abdomen, this test may be helpful. CTA pelvis may be ordered simultaneously; however, the primary role would be for vascular access mapping. 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 comparing the use of CTA chest without and with IV contrast for UGIB. However, as highlighted earlier in this document, if the known source of bleeding is localized to the chest, this test may be helpful. 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 overt UGIB, which is untreatable by endoscopy.
Nonvariceal Upper Gastrointestinal Bleeding. However, the use of these virtual unenhanced images in place of true unenhanced images is still limited to certain sites and remains a user-specific preference. So, they are not discussed in this document. CTA Abdomen and Pelvis Without and With IV Contrast Although there is no literature to discuss the difference between diagnostic accuracy of CTA abdomen and pelvis without and with IV contrast versus CTA abdomen without and with IV contrast or CTA chest without and with IV contrast, in patients with a known source of bleeding that cannot be controlled endoscopically, the imaging should be tailored to include the site of the bleeding. Overall, CTA has good accuracy for the detection of tumor bleeding, vascular malformations, or diverticular bleeding [7,42,43]. 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 comparing the use of CTA abdomen and pelvis without and with IV contrast for UGIB. However, as highlighted earlier in this document, if the known source of bleeding if localized to abdomen, this test may be helpful. CTA pelvis may be ordered simultaneously; however, the primary role would be for vascular access mapping. 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 comparing the use of CTA chest without and with IV contrast for UGIB. However, as highlighted earlier in this document, if the known source of bleeding is localized to the chest, this test may be helpful. 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 overt UGIB, which is untreatable by endoscopy.