Additional Modalities for Workup of GI Bleed (Other than EGD + Colonoscopy) Pill endoscopy • Able to assess sites beyond push and double-balloon endoscopy limits, high sensitivity for detection of most small-bowel diseases • Contraindicated in small-bowel stricture, limited anatomic localization, non-therapeutic, massive bleed may obscure bleeding site Triple-phase CT Enterography • Able to image the mesenteric vasculature in addition to the small bowel mucosa, lumen, and wall, noninvasive • Non-therapeutic, contrast allergy or nephropathy CT angiography • Precise localization, noninvasive, rapid and easy to perform • Non-therapeutic, contrast allergy or nephropathy Mesenteric Angiography • Therapeutic • Invasive, contrast allergy or nephropathy, unable to perform prolonged imaging Meckel's Scan • Noninvasive • False positives can be seen in the presence of small bowel duplication cysts, intussusception, and inflammatory bowel disease Deep Enteroscopy (e.g., push, double balloon, spiral) • Therapeutic, able to tattoo sites for future localization • Invasive, technically challenging Laparoscopy/laparotomy with intraoperative endoscopy • Able to assess and intervene on sites beyond push and double-balloon endoscopy limits • Invasive, technically challenging Tagged RBC Scan • Most sensitive, noninvasive, ability to image over a prolonged period • Poor anatomic localization, unable to identify pathology, non-therapeutic Matthew Ho, MD PhD @MatthewHoMD #GI #Bleed #GIBleed #management #gastroenterology #table #imaging #modalities
