Does performing Computed Tomography Angiography following abnormal gastrointestinal bleeding scans benefit patients

1673 Objectives We have noticed that after some positive gastrointestinal bleeding scans (GIBS), a Computed Tomography Angiography (CTA) is ordered instead of proceeding directly to intervention. We sought to investigate the diagnostic yield of the CTA in this setting since CTA adds cost, radiation, and time to patient management. Methods We retrospectively reviewed all positive GIBS over a two year period from September 1, 2012 to August 31, 2014. For each of these patients, we identified if a CTA of the abdomen and pelvis was subsequently performed and compared the CTA results to the GIBS findings. CTA’s performed more than 48 hours after the positive GIBS result were excluded. The time between the GIBS result and CTA result was also examined. Results Two-hundred ninety-four patients with positive GIBS were identified. In 244/294 (83%) of cases the GIBS localized the bleeding site and in 50/294 (17%) the GI bleeding site could not be localized. In patients with localized GIBS, 220/244 (90%) did not have a CTA done and 25/244 (10%) had a CTA performed; the CTA was negative in 16/25 (64%) and positive for bleeding in 9/25 (36%). All 9 of the positive CTA’s agreed with the GI bleeding site identified on GIBS. In patients with positive GIBS but bleeding site was not localized, 46/50 (92%) did not have a CTA and 4/50 (8%) had a CTA all of which were negative. Overall, the CTA’s added a mean of 13.1 hours to patient management. Conclusions Performing CTA following positive GIBS does not assist in localizing the site of bleeding, is often falsely negative in patients in whom bleeding has already been demonstrated, and may unnecessarily delay management in actively bleeding patients.