Browsing by Author "Wells, Michael L."

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    Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey
    (2022) Fidler, Jeff L.; Guglielmo, Flavius F.; Brook, Olga R.; Strate, Lisa L.; Bruining, David H.; Gupta, Avneesh; Allen, Brian C.; Anderson, Mark A.; Wells, Michael L.; Ramalingam, Vijay; Gunn, Martin L.; Grand, David J.; Gee, Michael S.; Huete, Alvaro; Khandalwal, Ashish; Sokhandon, Farnoosh; Park, Seong Ho; Yoo, Don C.; Soto, Jorge A.
    Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 ( 40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable ( n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding.
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    The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology
    (2024) Sengupta, Neil; Kastenberg, David M.; Bruining, David H.; Latorre, Melissa; Leighton, Jonathan A.; Brook, Olga R.; Wells, Michael L.; Guglielmo, Flavius F.; Naringrekar, Haresh V.; Gee, Michael S.; Soto, Jorge A.; Park, Seong Ho; Yoo, Don C.; Ramalingam, Vijay; Huete, Alvaro; Khandelwal, Ashish; Gupta, Avneesh; Allen, Brian C.; Anderson, Mark A.; Dane, Bari R.; Sokhandon, Farnoosh; Grand, David J.; Tse, Justin R.; Fidler, Jeff L.
    Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.