Review
English
Anuj Mishra ¹, Ehtuish. F. Ehtuish ²
1-Department of Radiology, 2-Department of Surgery, National Organ Transplant Program, Tripoli Central Hospital, Tripoli, Libya
JMJ Vo1. 8 No.4 (Winter) 2008:251-257
Abstract
Objective: To perform a systematic review determining the accuracy of helical computed tomography (CT) in diagnosis of acute gastrointestinal bleeding. Materials and methods: A literature search of Medline and manual searching of the reference lists of relevant primary and review articles was conducted. Studies were included if they compared helical CT to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography, or surgery in the context of acute gastrointestinal bleeding. Results: 8 published studies evaluating 129 patients were included. Data were used to form 2×2 tables using endoscopy, colonoscopy, angiography, and surgery as the reference standard.
Helical CT demonstrated pooled sensitivity of 86% (95% CI 78%-92%) and specificity of 95% (95%CI 76%-100%), without demonstrating significant heterogeneity (<2=3.5, P=0.6) and (<2=5.4, P=0.6) respectively. Summary receiver operating characteristic (SROC) analysis demonstrated an area under the curve (AUC) of 0.93. Conclusion: Helical CT is accurate in the diagnosis of acute gastrointestinal bleeding, and can demonstrate the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review due to the methodological limitations of included studies, and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.
Keywords: Angiography, Gastrointestinal Hemorrhage, Meta-Analysis, Sensitivity and Specificity, Tomography, X-Ray Computed.
Link/DOI: http://www.jmj.org.ly/PDF/winter2008/251.pdf