Endoscopy confirms nonvariceal upper gastrointestinal bleeding with a clear source, but treatment not possible or continued bleeding after endoscopic treatment. Initial imaging. This variant is applicable in a clinical scenario when the patient had endoscopy performed, which diagnosed the upper GI tract as the source of bleed, but definitive treatment of the bleeding was not possible or there is continued bleeding after treatment. Arteriography Visceral There is an 88% to 100% success rate of VA for diagnosis of endoscopically refractory bleeding from the esophagus due to inflammatory or neoplastic pathology [26,27] or periesophageal pseudoaneurysm [28]. In a study among patients with postesophagectomy gastric conduit hemorrhage [29], VA identified the source of active bleeding in 85% of patients. In a study among patients with gastric cancer refractory to endoscopy, angiography could diagnose active bleeding in 22.4% (13/58) of patients [30]. In other studies in patients with bleeding GI tumors, VA showed active bleeding in 25% to 55% of patients [31,32]. Among patients with pancreatic cancer presenting with endoscopically refractory UGIB, angiography detected active bleeding in 81% of patients [33,34]. Although there is more literature on clinical success of angiographic embolization for treatment of gastric and duodenal ulcers refractory to endoscopic treatment [34-37], duodenal fistula [38], and iatrogenic bleeding following laparoscopic cholecystectomy or endoscopic pancreaticobiliary drainage [4,39,40], the literature on diagnostic accuracy for bleeding is limited in these studies. CT Abdomen and Pelvis With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis with IV contrast. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without and with IV contrast.
Nonvariceal Upper Gastrointestinal Bleeding. Endoscopy confirms nonvariceal upper gastrointestinal bleeding with a clear source, but treatment not possible or continued bleeding after endoscopic treatment. Initial imaging. This variant is applicable in a clinical scenario when the patient had endoscopy performed, which diagnosed the upper GI tract as the source of bleed, but definitive treatment of the bleeding was not possible or there is continued bleeding after treatment. Arteriography Visceral There is an 88% to 100% success rate of VA for diagnosis of endoscopically refractory bleeding from the esophagus due to inflammatory or neoplastic pathology [26,27] or periesophageal pseudoaneurysm [28]. In a study among patients with postesophagectomy gastric conduit hemorrhage [29], VA identified the source of active bleeding in 85% of patients. In a study among patients with gastric cancer refractory to endoscopy, angiography could diagnose active bleeding in 22.4% (13/58) of patients [30]. In other studies in patients with bleeding GI tumors, VA showed active bleeding in 25% to 55% of patients [31,32]. Among patients with pancreatic cancer presenting with endoscopically refractory UGIB, angiography detected active bleeding in 81% of patients [33,34]. Although there is more literature on clinical success of angiographic embolization for treatment of gastric and duodenal ulcers refractory to endoscopic treatment [34-37], duodenal fistula [38], and iatrogenic bleeding following laparoscopic cholecystectomy or endoscopic pancreaticobiliary drainage [4,39,40], the literature on diagnostic accuracy for bleeding is limited in these studies. CT Abdomen and Pelvis With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis with IV contrast. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without and with IV contrast.