P0595 - Use of Computed Tomography Angiography in the Evaluation of Patients Presenting With Gastrointestinal Bleeding

John W. Boyd, MD¹, Brittany Fields, PA-C¹, Mark Titus, MD¹, Timothy Lee, APN¹, Anne Kennedy, APN¹, Ben Ingerson, PA-C^2
1Riverside Medical Group, Newport News, VA; ²Riverside Medical Group, Newport News, VA

Introduction: Currently in our emergency department (ED) urgent computed tomography angiography (CTA) is being utilized to evaluate patients presenting with gastrointestinal (GI) bleeding. It is not clear whether or not urgent CTA is helpful in this clinical setting.

Methods: Over a period of 6 months (NOV 2021 - APR 2022) 101 patients presenting with symptoms of GI bleeding underwent CTA upon presentation to the ED at Riverside Regional Medical Center. Patient charts were reviewed retrospectively to determine if urgent CTA in this setting was clinically helpful. The average patient age was 66 (26-99 yrs). All CTAs were ordered while the pt was being evaluated in the ED.

Results: Of the 101 CTAs performed over 6 months, 15 were positive for active bleeding. Indications included: 32 patients with upper GI bleeding symptoms (melena / hematemesis) and 69 patients with lower GI bleeding symptoms (red blood per rectum). Most of the patents (90%, 90/101) were admitted to the hospital . CTA imaging was positive in only 3% ( 1/32 ) of patients presenting with symptoms of upper GI bleeding. The only patient with symptoms of upper GI bleeding that had a positive CTA was a patient with bleeding after an esophageal dilation, managed endoscopically. CTA imaging was positive in 20% (14/69) of patients with symptoms of lower GI bleeding. Of the patients with a positive CTA for lower GI bleeding, the majority (9/14) were diverticular in origin. Of the patients with positive CTA results 20% (3/15) underwent interventional radiology (IR) to stop bleeding. The patients who did not undergo IR for a positive CTA ( 12/15 ) either had resolution of GI bleeding symptoms or were treated endoscopically. A small number of patients, 4% (3/86) with negative CTA imaging had unexpected findings that changed their clinical care, these included: incarcerated hernia, colon intussuception and contained perforation. Overall CTA imaging in the ED in the evaluation of patients with symptoms of GI bleeding changed clinical care or led to angiographic intervention in 6% of patients ( 6/101).

Discussion: In this retrospective study, if CTA imaging to evaluate symptoms of GI bleeding had been limited only to patients with symptoms of lower GI bleeding, 32 % (32/101) fewer patients would have undergone CTA imaging for the same clinical benefit. The use of CTA imaging in the ED to evaluate patients with GI bleeding seems most helpful when limited to symptoms of lower GI bleeding.


Disclosures:


John W. Boyd, MD¹, Brittany Fields, PA-C¹, Mark Titus, MD¹, Timothy Lee, APN¹, Anne Kennedy, APN¹, Ben Ingerson, PA-C². P0595 - Use of Computed Tomography Angiography in the Evaluation of Patients Presenting With Gastrointestinal Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.