RBC Scan Abdomen and Pelvis There is no significant literature to support the use of a Tc-99m-labeled RBC scan of the abdomen and pelvis for the diagnosis of GIB when the source of bleeding is obvious but unmanageable on endoscopy. Nonvariceal Upper Gastrointestinal Bleeding Variant 3: Adult. Endoscopy confirms nonvariceal upper gastrointestinal bleeding without a clear source. Initial imaging. This variant is applicable to clinical scenario in which endoscopy shows UGIB but the site or source of the bleeding cannot be determined on endoscopy. Clinically, these patients typically present with overt GIB. Arteriography Visceral VA can be attempted in such cases; however, it also has the limitation that if the bleeding is not active, it may not be seen. VA has the advantage of assessing the entire mesenteric circulation. Provocation techniques including intraprocedure heparin administration, intra-arterial nitroglycerin administration, and low-dose tissue plasminogen activator administration have been shown to increase the sensitivity of VA for the detection of GIB [44]. However, the literature on safety of these maneuvers and the effect on patient outcomes is limited. The other methods described in the literature that can enhance detection of bleeding on VA are glucagon and hyoscine butylbromide administration (to decrease bowel motility and artifacts), the use of carbon dioxide as a contrast medium, and longer injection durations [45]. Limitations include its invasive nature and higher bleeding rate threshold to diagnose obscure bleeding [46]. 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. RBC Scan Abdomen and Pelvis There is no significant literature to support the use of a Tc-99m-labeled RBC scan of the abdomen and pelvis for the diagnosis of GIB when the source of bleeding is obvious but unmanageable on endoscopy. Nonvariceal Upper Gastrointestinal Bleeding Variant 3: Adult. Endoscopy confirms nonvariceal upper gastrointestinal bleeding without a clear source. Initial imaging. This variant is applicable to clinical scenario in which endoscopy shows UGIB but the site or source of the bleeding cannot be determined on endoscopy. Clinically, these patients typically present with overt GIB. Arteriography Visceral VA can be attempted in such cases; however, it also has the limitation that if the bleeding is not active, it may not be seen. VA has the advantage of assessing the entire mesenteric circulation. Provocation techniques including intraprocedure heparin administration, intra-arterial nitroglycerin administration, and low-dose tissue plasminogen activator administration have been shown to increase the sensitivity of VA for the detection of GIB [44]. However, the literature on safety of these maneuvers and the effect on patient outcomes is limited. The other methods described in the literature that can enhance detection of bleeding on VA are glucagon and hyoscine butylbromide administration (to decrease bowel motility and artifacts), the use of carbon dioxide as a contrast medium, and longer injection durations [45]. Limitations include its invasive nature and higher bleeding rate threshold to diagnose obscure bleeding [46]. 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.