Computed tomography versus lower endoscopy as initial diagnostic method for evaluating patients with hematochezia at emergency room

For acute lower gastrointestinal bleeding (LGIB), lower gastrointestinal endoscopy is the preferred initial diagnostic test. However, it is difficult to perform urgently. Computed tomography (CT) is a convenient alternative.This study aimed to determine the diagnostic performance of CT compared to l...

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Bibliographic Details
Published in:Medicine (Baltimore) 2020-05, Vol.99 (22), p.e20311-e20311
Main Authors: Lee, Hee Sung, Kang, Sun Hyung, Rou, Woo Sun, Eun, Hyuk Soo, Joo, Jong Seok, Kim, Ju Seok, Lee, Eaum Seok, Moon, Hee Seok, Kim, Seok Hyun, Sung, Jae Kyu, Lee, Byung Seok, Jeong, Hyun Yong
Format: Article
Language:English
Subjects:
Academic Medical Centers
Adult
Aged
Aged, 80 and over
Colonoscopy - methods
Colonoscopy - standards
Female
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - diagnostic imaging
Humans
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Sigmoidoscopy - methods
Sigmoidoscopy - standards
Tomography, X-Ray Computed - methods
Tomography, X-Ray Computed - standards
Young Adult
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Summary:For acute lower gastrointestinal bleeding (LGIB), lower gastrointestinal endoscopy is the preferred initial diagnostic test. However, it is difficult to perform urgently. Computed tomography (CT) is a convenient alternative.This study aimed to determine the diagnostic performance of CT compared to lower endoscopy as an initial test for evaluating acute LGIB.The medical records of 382 patients who visited our emergency department with hematochezia between January 2012 and January 2017 were retrospectively analyzed. Of them, 112 underwent CT, 65 underwent colonoscopy, and 205 underwent sigmoidoscopy as an initial test. For each method, sensitivity, specificity, positive predictive value, and negative predictive value were calculated upon active bleeding site detection and LGIB etiology diagnosis.The sensitivity, specificity, positive predictive value, and negative predictive value of CT for active bleeding site detection were 85.7%, 100%, 100%, and 96.9%, respectively, while those for identifying the etiology of LGIB were 87.4%, 40.0%, 83.5, and 47.6%, respectively.CT was not inferior to lower endoscopy for active bleeding site detection. Early localization and the exclusion of active bleeding were possible with CT. Etiology was diagnosed with high sensitivity and PPV by CT. Thus, CT can be an alternative initial diagnostic tool for evaluating acute LGIB.
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000020311