CTA-positive, angiography-negative lower GI bleeding: an institutional imaging-guided management algorithm

Wortman JR, Landman W, Fulwadhva UP, Viscomi SG, Sodickson AD (2017) CT angiography for acute gastrointestinal bleeding: what the radiologist needs to know. Br J Radiol 90(1075):20170076. https://doi.org/10.1259/bjr.20170076

Article  PubMed  PubMed Central  Google Scholar 

Antonucci E, Zanichelli I, & Rimondi A (2026) Acute Gastrointestinal Bleeding: An Update and a Practical Diagnostic Approach. Diagnostics (Basel, Switzerland), 16(6):860. https://doi.org/10.3390/diagnostics16060860

Sengupta N, Feuerstein JD, Jairath V, Shergill AK, Strate LL, Wong RJ, Wan D (2023) Management of patients with acute lower gastrointestinal bleeding: an updated ACG guideline. Am J Gastroenterol 118(2):208–231. https://doi.org/10.14309/ajg.0000000000002130

Article  PubMed  Google Scholar 

Vora P, Pietila A, Peltonen M, Brobert G, Salomaa V (2020) Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open 3(10):e2020172. https://doi.org/10.1001/jamanetworkopen.2020.20172

Article  PubMed  PubMed Central  Google Scholar 

Guo CG, Zhang F, Wu JT, Cheung KS, Li B, Law SYK, Leung WK (2021) Divergent trends of hospitalizations for upper and lower gastrointestinal bleeding based on population prescriptions of aspirin, proton pump inhibitors and Helicobacter pylori eradication therapy. United Eur Gastroenterol J 9(5):543–551. https://doi.org/10.1002/ueg2.12067

Article  CAS  Google Scholar 

Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR (2011) Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 60(10):1327–1335. https://doi.org/10.1136/gut.2010.228437

Article  PubMed  Google Scholar 

Oakland K, Guy R, Uberoi R, Hogg R, Mortensen N, Murphy MF, Jairath V, UK Lower GI Bleeding Collaborative (2018) Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit. Gut 67(4):654–662. https://doi.org/10.1136/gutjnl-2016-313428

Article  PubMed  Google Scholar 

Cea Soriano L, Lanas A, Soriano-Gabarró M, García Rodríguez LA (2019) Incidence of upper and lower gastrointestinal bleeding in new users of low-dose aspirin. Clin Gastroenterol Hepatol 17(5):887–895e6. https://doi.org/10.1016/j.cgh.2018.05.061

Article  CAS  PubMed  Google Scholar 

Troelsen FS, Farkas DK, Erichsen R, Sørensen HT (2020) Risk of lower gastrointestinal bleeding and colorectal neoplasms following initiation of low-dose aspirin: a Danish population-based cohort study. BMJ open Gastroenterol 7(1):e000453. https://doi.org/10.1136/bmjgast-2020-000453

Article  PubMed  PubMed Central  Google Scholar 

Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT (2011) Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 140(5):1427–1433. https://doi.org/10.1053/j.gastro.2011.02.004

Article  CAS  PubMed  PubMed Central  Google Scholar 

Oakland K, Jairath V, Uberoi R, Guy R, Ayaru L, Mortensen N, Murphy MF, Collins GS (2017) Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol 2(9):635–643. https://doi.org/10.1016/S2468-1253(17)30150-4

Article  PubMed  Google Scholar 

Chung W, Rich H, Wands J (2022) A predictive model for the diagnostic and therapeutic yield of colonoscopy performed for lower gastrointestinal bleeding. J Clin Gastroenterol 56(2):154–160. https://doi.org/10.1097/MCG.0000000000001492

Article  CAS  PubMed  Google Scholar 

Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Fidler JL (2024) The role of imaging for gastrointestinal bleeding: consensus recommendations from the American College of Gastroenterology and Society of Abdominal Radiology. Am J Gastroenterol 119(3):438–449. https://doi.org/10.14309/ajg.0000000000002631

Article  PubMed  Google Scholar 

Gomez E, Horton K, Fishman EK, Johnson PT (2022) CT of acute abdominopelvic hemorrhage: protocols, pearls, and pitfalls. Abdom Radiol (New York) 47(1):475–484. https://doi.org/10.1007/s00261-021-03336-w

Article  Google Scholar 

Expert Panel on Interventional Radiology, Karuppasamy K, Kapoor BS, Fidelman N, Abujudeh H, Bartel TB, Caplin DM, Cash BD, Citron SJ, Farsad K, Gajjar AH, Guimaraes MS, Gupta A, Higgins M, Marin D, Patel PJ, Pietryga JA, Rochon PJ, Stadtlander KS, Lorenz JM (2021) ACR appropriateness criteria® radiologic management of lower gastrointestinal tract bleeding: 2021 update. J Am Coll Radiol 18(5S):S139–S152. https://doi.org/10.1016/j.jacr.2021.02.018

Article  Google Scholar 

Aoki T, Nagata N, Niikura R, Shimbo T, Tanaka S, Sekine K, Kishida Y, Watanabe K, Sakurai T, Yokoi C, Akiyama J, Yanase M, Mizokami M, Uemura N (2015) Recurrence and mortality among patients hospitalized for acute lower gastrointestinal bleeding. Clin Gastroenterol Hepatol 13(3):488–494e1. https://doi.org/10.1016/j.cgh.2014.06.023

Article  PubMed  Google Scholar 

Radaelli F, Frazzoni L, Repici A, Rondonotti E, Mussetto A, Feletti V, Spada C, Manes G, Segato S, Grassi E, Musso A, Di Giulio E, Coluccio C, Manno M, De Nucci G, Festa V, Di Leo A, Marini M, Ferraris L, Fuccio L (2021) Clinical management and patient outcomes of acute lower gastrointestinal bleeding: a multicenter, prospective, cohort study. Dig Liver Dis 53(9):1141–1147. https://doi.org/10.1016/j.dld.2021.01.002

Article  PubMed  Google Scholar 

Chan V, Tse D, Dixon S, Shrivastava V, Bratby M, Anthony S, Patel R, Tapping C, Uberoi R (2015) Outcome following a negative CT angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol 38(2):329–335. https://doi.org/10.1007/s00270-014-0928-8

Article  PubMed  Google Scholar 

Tse JR, Shen J, Shah R, Fleischmann D, Kamaya A (2021) Extravasation volume at computed tomography angiography correlates with bleeding rate and prognosis in patients with overt gastrointestinal bleeding. Invest Radiol 56(6):394–400. https://doi.org/10.1097/RLI.0000000000000753

Article  CAS  PubMed  Google Scholar 

Speir EJ, Newsome JM, Bercu ZL, Miller MJ Jr., Martin JG (2019) Correlation of CT angiography and ⁹⁹mTechnetium-labeled red blood cell scintigraphy to catheter angiography for lower gastrointestinal bleeding: a single-institution experience. J Vasc Interv Radiol 30(11):1725–1732e7. https://doi.org/10.1016/j.jvir.2019.04.019

Article  PubMed  Google Scholar 

Clerc D, Grass F, Schäfer M, Denys A, Demartines N, Hübner M (2017) Lower gastrointestinal bleeding: computed tomographic angiography, colonoscopy or both? World J Emerg Surg 12:1. https://doi.org/10.1186/s13017-016-0112-3

Article  PubMed  PubMed Central  Google Scholar 

Koh FH, Soong J, Lieske B, Cheong WK, Tan KK (2015) Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference? Int J Colorectal Dis 30(1):57–61. https://doi.org/10.1007/s00384-014-2055-z

Article  PubMed  Google Scholar 

Kariya S, Nakatani M, Ono Y, Maruyama T, Ueno Y, Yoshida A, Komemushi A, Tanigawa N (2020) Provocative angiography for lower gastrointestinal bleeding. Jpn J Radiol 38(3):248–255. https://doi.org/10.1007/s11604-019-00909-0

Article  PubMed  Google Scholar 

Thiry GJH, Dhand S, Gregorian A, Shah N (2022) Provocative mesenteric angiography: outcomes and standardized protocol for management of recurrent lower gastrointestinal hemorrhage. J Gastrointest Surg 26(3):652–654. https://doi.org/10.1007/s11605-021-05131-w

Article  PubMed  Google Scholar 

Benvenuti TA, Chisholm M, Cline B, Johnson DY, Befera NT, Mastria EM, Martin JG, Ronald J, Pabon-Ramos W, Suhocki PV, Smith TP, Kim CY (2025) Provocative mesenteric angiography for obscure gastrointestinal hemorrhage: an update on outcomes, safety, and predictors of success. J Vasc Interv Radiol 36(10):1558–1566. https://doi.org/10.1016/j.jvir.2025.06.022

Article  PubMed  Google Scholar 

Lauricella S, Sylla P (2021) Management of lower GI bleeding. In ACS manual of gastrointestinal surgery (pp. 142–164). American College of Surgeons. https://www.facs.org/media/o1gazfwy/2021_ms_gisemanual_final_01_22.pdf

Hermie L, Dhondt E, Vanlangenhove P, De Waele J, Degroote H, Defreyne L (2021) Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding. Eur Radiol 31(4):2161–2172. https://doi.org/10.1007/s00330-020-07232-7

Article  PubMed  Google Scholar 

Liang HL, Chiang CL, Li MF (2024) Empiric embolization by vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report. Sci Rep 14(1):25728. https://doi.org/10.1038/s41598-024-76408-8

Article  CAS  PubMed  PubMed Central  Google Scholar 

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