However, Tc-99m-labeled RBC scanning can be used to localize a low-rate source of bleeding. Variant 4: Adult. Nonvariceal upper gastrointestinal bleeding; negative endoscopy. Initial imaging. This variant is applicable to patients with no clear source of bleeding despite complete endoscopic evaluation. Clinically, these patients can have obscure bleeding (which may be noted in the form of visible passage of blood or melena or occult bleeding, unexplained iron deficiency anemia, or guaiac-positive stools without visible passage of blood). Small bowel pathology is the frequent source of bleeding in these patients. Arteriography Visceral VA, due to a lower sensitivity for the detection of bleeding and its invasive nature, is considered lower on the diagnostic algorithm compared with more sensitive noninvasive testing [49,50]. Super-selective angiography with intraoperative methylene blue localization may help to diagnose and effectively control bleeding in patients with obscure GIB [51]. In patients with negative endoscopy, VA has false-negative results, because the bleeding is typically detected when the rate is at least 0.5 mL/min. It has been shown that there is no benefit of performing angiography in patients with occult GIB who have a negative CTA study [50]. CT Abdomen and Pelvis With IV Contrast In endoscopy-negative patients, there is no significant literature for CT abdomen and pelvis with IV contrast for GIB evaluation. However, CT may be performed primarily for the evaluation of GI masses rather than the demonstration of bleeding. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CT abdomen and pelvis without and with IV contrast for GIB evaluation.
Nonvariceal Upper Gastrointestinal Bleeding. However, Tc-99m-labeled RBC scanning can be used to localize a low-rate source of bleeding. Variant 4: Adult. Nonvariceal upper gastrointestinal bleeding; negative endoscopy. Initial imaging. This variant is applicable to patients with no clear source of bleeding despite complete endoscopic evaluation. Clinically, these patients can have obscure bleeding (which may be noted in the form of visible passage of blood or melena or occult bleeding, unexplained iron deficiency anemia, or guaiac-positive stools without visible passage of blood). Small bowel pathology is the frequent source of bleeding in these patients. Arteriography Visceral VA, due to a lower sensitivity for the detection of bleeding and its invasive nature, is considered lower on the diagnostic algorithm compared with more sensitive noninvasive testing [49,50]. Super-selective angiography with intraoperative methylene blue localization may help to diagnose and effectively control bleeding in patients with obscure GIB [51]. In patients with negative endoscopy, VA has false-negative results, because the bleeding is typically detected when the rate is at least 0.5 mL/min. It has been shown that there is no benefit of performing angiography in patients with occult GIB who have a negative CTA study [50]. CT Abdomen and Pelvis With IV Contrast In endoscopy-negative patients, there is no significant literature for CT abdomen and pelvis with IV contrast for GIB evaluation. However, CT may be performed primarily for the evaluation of GI masses rather than the demonstration of bleeding. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast In endoscopy-negative patients, there is no significant literature for CT abdomen and pelvis without and with IV contrast for GIB evaluation.