Colonoscopy Versus Catheter Angiography for Lower Gastrointestinal Bleeding After Localization on CT Angiography |
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| Institution: | 1. Department of Radiology, Stanford University School of Medicine, Stanford, California;2. Department of Radiological Sciences, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California;3. Assistant Director of Research Evaluation and Assessment, Department of Radiology, Stanford University School of Medicine, Stanford, California;4. Assistant Fellowship Program Director, Cardiovascular Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California;5. Co-Chair, ACR Ultrasound LI-RADS®;6. Division Chief, Director of Ultrasound, and Assistant Fellowship Program Director, Body Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California;1. Associate Director of Center for Evidence Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, and Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts;2. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;3. Fellowship Director, Cardiothoracic Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, and Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts;4. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, and Instructor in Radiology, Harvard Medical School, Boston, Massachusetts;5. Director of Diversity, Inclusion, and Equity, and Quality and Safety Officer, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, and Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts;6. Vice Chair of Radiology, Distinguished Chair, Medical Informatics, and Director of Center for Evidence Based Imaging, Department of Radiology, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, and Professor of Radiology, Harvard Medical School, Boston, Massachusetts;1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;2. Radiology Quality and Patient Safety Officer, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Vice Chair for Quality, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Associate Chair for Enterprise Informatics/IT, Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts;1. Assistant Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;2. Clinical Research Coordinator, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;3. Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;1. Resident, Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University, Stanford, California;2. Resident, Division of Vascular and Interventional Radiology, Department of Radiology, Duke University, Durham, North Carolina;3. Medical student, Chicago Medical School, North Chicago, Illinois;4. Resident, Case Western Reserve University School of Medicine, Cleveland, Ohio;5. Associate Chair of Clinical Performance Improvement, Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University, Stanford, California;1. Michigan Medicine, Ann Arbor, Michigan;2. University of Massachusetts Memorial Medical Center, Worcester, Massachusetts;1. Member, Board of Advisors, Baobab Studios, Redwood City, California;2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Division Chief, Diagnostic Division, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland;4. Associate Division Chief, Diagnostic Division, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland |
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| Abstract: | PurposeThe aim of this study was to compare catheter angiography (CA) and colonoscopy outcomes after successful CT angiographic (CTA) localization for patients with overt lower gastrointestinal bleeding (LGIB).MethodsSeventy-one consecutive patients from two institutions between 2010 and 2020 had both contrast extravasation on CTA imaging in the lower gastrointestinal tract and subsequent CA or colonoscopy. The primary outcome was confirmation of active bleeding during CA or colonoscopy (defined as confirmation yield). The secondary outcomes were to determine therapeutic yield (hemostatic therapy), time to procedure, rebleeding rate, and adverse outcome rates (defined as surgery, acute kidney injury, initiation of dialysis, and overall mortality). Univariate analyses and multivariable analyses with P < .05 were used to determine statistical significance.ResultsForty-four patients underwent CA and 27 underwent colonoscopy. CA had higher overall confirmation yield (55% vs 26%, P = .026), whereas therapeutic yields were similar (70% vs 56%, P = .214). Time to procedure was 5.1 ± 3.4 hours for CA and 15.5 ± 13.6 hours for colonoscopy (P < .001). On multivariable analysis, shorter time to procedure was the only statistically significant predictor of confirmation yield (P = .037) and therapeutic yield (P = .013), whereas procedure, hemoglobin, transfusions, and hemodynamic instability were not. Adverse events and rebleeding were not statistically different between patients who underwent CA and colonoscopy (P > .05).ConclusionsShorter time to procedure was the only statistically significant predictor of confirmation and therapeutic yield after CTA localization of LGIB. Because CA can be performed sooner than colonoscopy without increased rates of adverse outcomes or rebleeding, CA may be a reasonable first-line treatment option in patients with CTA localization of LGIB. |
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| Keywords: | Lower gastrointestinal bleeding catheter angiography colonoscopy active extravasation |
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