CTA Abdomen Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA abdomen without and with IV contrast for GIB evaluation. Because the pathology can be located anywhere in the small bowel, it is more appropriate to image both the abdomen and pelvis. CTA Chest With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA chest with IV contrast for GIB evaluation. CTA Chest Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA chest without and with IV contrast for GIB evaluation. Fluoroscopy Upper GI Series Barium or iodine upper GI series has no role in diagnosis of acute UGIB. MR Enterography Similar to CT enterography, MR enterography requires oral administration of oral contrast that can obscure bleeding. But MR enterography has been used to identify small bowel sources of bleeding in pediatric patients. In a study of 25 pediatric patients with occult GIB, MR enterography was shown to be diagnostic in 79% patients, with a sensitivity and specificity of 86% and 100%, respectively [59]. Few other studies have also compared capsule with MR enterography and demonstrated better diagnostic yields for capsule endoscopy [60,61]. However, there is Nonvariceal Upper Gastrointestinal Bleeding not enough direct evidence to suggest that MR enterography has an advantage over CT enterography or capsule endoscopy in patients with UGIB and negative endoscopy, particularly in adults. RBC Scan Abdomen and Pelvis Tc-99m-labeled RBC scans can detect bleeding rates as low as 0.05 to 0.1 mL/min. Although there is prior literature on the use of RBC abdomen and pelvis scan, no recent studies have compared the accuracy of RBC scan to CTA or angiography for occult UGIB. Prior reports had suggested variable efficacy for the diagnosis of GIB with localization errors, especially when bleeding arises from the stomach and duodenum [62,63].
Nonvariceal Upper Gastrointestinal Bleeding. CTA Abdomen Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA abdomen without and with IV contrast for GIB evaluation. Because the pathology can be located anywhere in the small bowel, it is more appropriate to image both the abdomen and pelvis. CTA Chest With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA chest with IV contrast for GIB evaluation. CTA Chest Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CTA chest without and with IV contrast for GIB evaluation. Fluoroscopy Upper GI Series Barium or iodine upper GI series has no role in diagnosis of acute UGIB. MR Enterography Similar to CT enterography, MR enterography requires oral administration of oral contrast that can obscure bleeding. But MR enterography has been used to identify small bowel sources of bleeding in pediatric patients. In a study of 25 pediatric patients with occult GIB, MR enterography was shown to be diagnostic in 79% patients, with a sensitivity and specificity of 86% and 100%, respectively [59]. Few other studies have also compared capsule with MR enterography and demonstrated better diagnostic yields for capsule endoscopy [60,61]. However, there is Nonvariceal Upper Gastrointestinal Bleeding not enough direct evidence to suggest that MR enterography has an advantage over CT enterography or capsule endoscopy in patients with UGIB and negative endoscopy, particularly in adults. RBC Scan Abdomen and Pelvis Tc-99m-labeled RBC scans can detect bleeding rates as low as 0.05 to 0.1 mL/min. Although there is prior literature on the use of RBC abdomen and pelvis scan, no recent studies have compared the accuracy of RBC scan to CTA or angiography for occult UGIB. Prior reports had suggested variable efficacy for the diagnosis of GIB with localization errors, especially when bleeding arises from the stomach and duodenum [62,63].