P3451 - The Impact of a CT Angiography-Guided Protocol for Severe Lower Gastrointestinal Bleeding on Utilization and Outcomes

Award: ACG Governors Award for Excellence in Clinical Research

Award: Presidential Poster Award

David Wan, BS, MD¹, Tracey Martin, MD², Tamasha Persaud, MD¹, Kevin Chan, MD³, Sunena Tewani, MD⁴, Patrick Scanlon, MD⁵, Patrick T.. Magahis, BA¹, Steven N. Mathews, MD⁶, Aiya Aboubakr, MD⁷, Lindsay Clarke, MD⁸, Srikanth Palanisamy, MD⁹, David Bodnar, MD¹, Sara Murphy, DO, MS¹⁰, Brett Fortune, MD, MS¹¹, Wenna Xi, PhD¹, Jennifer I. Lee, MD¹, Anuj Malhotra, MD^12
1Weill Cornell Medicine, New York, NY; ²SSM Health, St. Louis, MO; ³New York Presbyterian Weill Cornell, New York, NY; ⁴Rutgers Robert Wood Johnson Medical School, West Windsor, NJ; ⁵New York Presbyterian/Weill Cornell, New York, NY; ⁶New York-Presbyterian/Well Cornell Medicine, New York, NY; ⁷New York Presbyterian-Weill Cornell Medical Center, New York, NY; ⁸Brigham and Women's Hospital, Boston, MA; ⁹Stanford University, Palo Alto, CA; ¹⁰Mount Sinai, New York, NY; ¹¹Montefiore Einstein, Bronx, NY; ¹²New York University Langone Health, New York, NY

Introduction: Lower endoscopy for acute lower gastrointestinal bleeding (LGIB) generally has low therapeutic yield. Retrospective studies suggest that in patients with severe LGIB, CT angiography (CTA) can aid in bleeding localization and increase the therapeutic yield of interventional radiology (IR) or lower endoscopy. It is unknown if the uptake of CTAs can be increased and whether this can improve clinical outcomes. Thus, the primary aim of this study is to determine whether implementation of a multidisciplinary LGIB pathway can increase CTA utilization for severe LGIB. Secondary outcomes included rebleeding rates, readmission rates, and all-cause mortality.

Methods: This longitudinal cohort study included patients who presented to the emergency room at New York Presbyterian Hospital with severe acute LGIB from 12/15/19 to 4/15/23. Eligible patients included those with bright red blood per rectum or maroon stools and hemodynamic instability on presentation with heart rate greater than 100 bpm or systolic blood pressure less than 100 mmHg. A multidisciplinary pathway involving the emergency department, gastroenterology, and IR was implemented to obtain early CTAs. Patients who met eligibility criteria on presentation underwent CTA and if positive IR guided intervention. If the CTA was negative or IR embolization was unsuccessful, patients underwent colonoscopy for further evaluation. Results were compared to a retrospective cohort of patients with severe LGIB over the four-year period prior to implementation of the CTA-guided pathway. Fischer’s exact test was performed to study factors associated with positive CTA.

Results: Baseline and outcome data for both historical and intervention cohorts are shown in Table 1. Implementation of the CTA pathway increased CTA usage from 19/131 (14.5%) to 20/52 (38.5%) patients (p< 0.001). Of 41 total CTAs recorded, 12 were positive (29%). The Oakland score < 8 or hemoglobin >10 g/dL was associated with a negative CTA (p< 0.02). Overall, there were low rates of 30-day all-cause mortality (2.2%), bleeding-related mortality (1.1%), 30-day recurrent bleeding (4.4%), and 30-day readmission for GIB (2.2%), with no difference between the two groups.

Discussion: A multidisciplinary pathway more than doubled the percentage of CTAs performed for patients with severe LGIB. However, with an overall CTA positivity rate of 29%, there was no significant change in clinical outcomes such as rebleeding and mortality.


Disclosures:


David Wan, BS, MD¹, Tracey Martin, MD², Tamasha Persaud, MD¹, Kevin Chan, MD³, Sunena Tewani, MD⁴, Patrick Scanlon, MD⁵, Patrick T.. Magahis, BA¹, Steven N. Mathews, MD⁶, Aiya Aboubakr, MD⁷, Lindsay Clarke, MD⁸, Srikanth Palanisamy, MD⁹, David Bodnar, MD¹, Sara Murphy, DO, MS¹⁰, Brett Fortune, MD, MS¹¹, Wenna Xi, PhD¹, Jennifer I. Lee, MD¹, Anuj Malhotra, MD¹². P3451 - The Impact of a CT Angiography-Guided Protocol for Severe Lower Gastrointestinal Bleeding on Utilization and Outcomes, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.