Use and utility of radiology in the work-up of
GI bleeding
What are the options for diagnostic imaging studies in patients with GI bleeds? What are the benefits and limitations of each?
- Routine abdominal x-rays - These are often obtained, but in the absence of specific indication, they are often of limited help.
- Angiography - This can sometimes detect the site of bleeding, especially in obscure lower tract bleeds. With angiography, there is the possible of therapeutic embolization of the source. Also, local vasoconstrictors can be given to stop the bleed when doing an angiogram. Angiography is helpful when the bleeding rate is rather fast (0.5 ml/min)
- Technetium-labeled red cell scans (scintigraphy) can be used for very slow bleeds, or for bleeding from obscure sites. Scintigraphy is more sensitive than angiography, and can localize bleeding site at a rate of 0.1 ml/min).
There is controversy in the literature currently as to which test should be the initial test of choice. Often, the decision is based on local availability and consultant preference.