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Invited Commentary |

The Evolving Role of Computed Tomographic Angiography for Lower Gastrointestinal Hemorrhage

Amy L. Lightner, MD1; Marcia M. Russell, MD1,2
[+] Author Affiliations
1Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
2Surgical and Perioperative Careline, Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, California
JAMA Surg. 2015;150(7):657. doi:10.1001/jamasurg.2015.117.
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This Invited Commentary discusses the increasing use of computed tomographic angiography prior to visceral angiography for lower gastrointestinal hemorrhage and raises questions about clinical outcomes and costs to be considered before it is used routinely.

Despite advances in radiologic localization, lower gastrointestinal hemorrhage (LGIH) remains a significant cause of mortality, with a rate of 3.9%, which increases with hospitalization and hemodynamic instability.1 In this issue, Jacovides and colleagues2 sought to evaluate the implementation of a new evidence-based protocol to incorporate computed tomographic angiography (CTA) prior to visceral angiography (VA) for management of acute LGIH. They retrospectively reviewed medical records of patients who underwent VA 4 years before and 4 years after their institution’s protocol change, and had 5 main findings: (1) CTA became used more widely than nuclear scintigraphy after protocol implementation, (2) CTA had improved localization of the LGIH compared with nuclear scintigraphy, (3) patients received a higher contrast volume after protocol implementation owing to contrast administration with both CTA and VA, (4) this increase in contrast volume did not increase serum creatinine levels or rate of renal dysfunction, and (5) despite improved localization of the LGIH, CTA did not reduce fluoroscopy time, amount of contrast administered during VA, or the rate of successful embolization.

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