ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding

Expert Panels on Vascular Imaging and Gastrointestinal Imaging:

Research output: Contribution to journalArticle

Abstract

Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, “postsurgical and traumatic causes of UGIB; endoscopy contraindicated” is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)S177-S188
JournalJournal of the American College of Radiology
Volume14
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Endoscopy
Hemorrhage
Angiography
Guidelines
Gastrointestinal Endoscopy
Mortality
Expert Testimony
Portal Hypertension
Radiology
Catheters
Computed Tomography Angiography
Morbidity

Keywords

  • angiography
  • Appropriate Use Criteria
  • Appropriateness Criteria
  • AUC
  • CTA
  • GIB
  • nonvariceal upper gastrointestinal bleeding
  • Tc-99m-labeled RBC scan

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding. / Expert Panels on Vascular Imaging and Gastrointestinal Imaging:.

In: Journal of the American College of Radiology, Vol. 14, No. 5, 01.05.2017, p. S177-S188.

Research output: Contribution to journalArticle

Expert Panels on Vascular Imaging and Gastrointestinal Imaging:. / ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding. In: Journal of the American College of Radiology. 2017 ; Vol. 14, No. 5. pp. S177-S188.
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