First UK data for CT angiography in persisting upper GI bleeding

Correspondence to Dr Suneil A Raju, Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK; suneilraju@gmail.com We read with interest the study by S Kumar et al that noted that patients with new gastrointestinal (GI) bleeding during admission to the intensive care unit (ICU) were more likely to die during hospitalisation.1 GI bleeding cannot always be controlled or identified at gastroscopy; therefore, guidelines recommend radiological intervention.2 3 Radiological intervention may be of value in uncontrolled GI bleeding where a lesion has already been identified at endoscopy or if no lesion has been detected endoscopically but the patient continues to be haemodynamically unstable. The use of * allowed for all suffixes to be accepted.Table 1 Diagnostic yields of patients with upper gastrointestinal (GI) bleed undertaking a CT angiography (CTA) Author Year Country Patients (n) Methodology Diagnostic yield (%) Outcomes Raju 2017 UK 59 Retrospective analysis of endoscopy and radiology databases 56.1 16/41 embolised Scheffel4 2007 Switzerland 9 Unblinded, retrospective assessment of multi-detector-row CT 70 Post CT: 4× coiling, 3× stent graft insertion, 1× embolisation, 1× no finding Frattaroli5 2009 Italy 11 Blinded study of patients undergoing endoscopy and then multi-detector-row CT with diagnosis confirmed by angiography, surgery or postmortem findings 100 Site found in all cases, aetiology found in 90.9% of cases, in 2/6 pseudoaneuryms CTA found information not seen on endoscopy Chan6 2015 UK 81 Retrospective study of all patients having CT angiography for GI haemorrhage 20.7 18 positive CTAs (16× embolised, 1× surgery, 1× died), 63 negative CTAs (37× no rebleed, 19× embolised, 5× surgery, 1× repeat negative CTA, 1× died) Yoon7 2006 Korea 26 Prospective study of multi-detector row CT in major haemorrhage using angiography as reference standard 57.1 – Jaeckle8 2008 Germany 10 Multi-detector CT findings correlated to endoscopy, angiography or surgery 50 In all cases anatomical site identified Our retrospective analysis of endoscopy and radiology databases was used to identify patients who underwent radiological intervention for GI bleeding at Sheffield Teaching Hospitals over a 10-year period. [...]CTA has a diagnostic yield of 56.1% and embolisation rate of 69.6% in this UK study.