Imaging of Gastrointestinal Bleeding

Radiological imaging has played an increasingly important role in the diagnosis and management of gastrointestinal bleeding over the past 30 years. The initial description of selective mesenteric angiography in 1965 and radiolabeled sulfur colloid scintigraphy in 1977, along with subsequent refinements in these techniques, have had a significant effect in this regard. Current computed tomographic (CT) techniques, including multidetector CT, CT enterography (CTE), and CT angiography, as well as magnetic resonance enterography (MRE) are capable of playing a role in the evaluation of the patient with gastrointestinal bleeding. Mesenteric angiography in particular has allowed therapeutic intervention, and the evolution of selective coaxial catheter systems has improved the safety and efficacy of this modality in the therapeutic armamentarium. Given the fact that gastrointestinal bleeding results in up to 500,000 hospital admissions per year in the United States and that mortality rates as high as 23% may be associated with such presentations when bleeding is massive or recurrent, it is incumbent on the surgical provider to understand the utility and efficacy of these radiological techniques in the spectrum of patient evaluation and management. This review summarizes the current literature with regard to radiological imaging and its role in the care of the patient with gastrointestinal bleeding. Scintigraphy, angiography, and solid organ imaging techniques are discussed, including a review of their relative roles in comparison with those of nonradiological management tools such as endoscopy and surgical therapy.