A37 EFFICACY OF CTA IN DIAGNOSING NON-TRAUMATIC NON-VARICEAL GASTROINTESTINAL BLEEDING PRIOR TO TRANSARTERIAL EMBOLIZATION AFTER ENDOSCOPIC FAILURE IN MANAGING ACUTE GASTROINTESTINAL BLEEDING
Bibliographic record
Abstract
Non-variceal gastrointestinal bleeding (NVGIB) is associated with a high mortality and morbidity. 10–30% of these patients tend to fail endoscopy and receive transarterial embolization (TAE) as an alternative. Studies suggest that performing pre-angiography computed tomography angiography (CTA) increases the positive yield of visceral angiography. Our objective was to determine (1) the accuracy of CTA in diagnosing NVGIB following failed endoscopy and (2) the impact of CTA pre-TAE on the angiographic technique. Data was collected from 83 consecutive patients who presented to the emergency department with acute NVGIB and received TAE after endoscopy failed to manage their NVGIB. Of these 83 patients, 40 underwent pre-angiography CTA. These CTA examinations were retrospectively reviewed by 2 radiology residents and 2 staff radiologists. These findings were compared to angiography, or/and surgery. Inter-reader reliability was evaluated with kappa coefficient (κ). Sensitivity, specificity, PPV, NPV, and accuracy of CTA in diagnosing NVGIB was 89%, 100%, 100%, 86%, and 93%, respectively. CTA was able to accurately diagnose the cause and source of NVGIB in 85% of the patients respectively. The inter-reader reliability coefficient for identifying the cause and source of NVGIB was κ=0.72 and κ=0.66 respectively. In 20 cases, in whom CTA localized NVGIB, no diagnostic catheter angiogram was required. In 6/20 cases, pre-TAE CTA enabled the identification of the bleeding site, which would not have been visualized on a routine diagnostic angiogram. When comparing patients that received CTA prior to their therapeutic embolization for NVGIB to the patients that did not receive a pre-embolization CTA, there was an overall reduction of 20 minutes of procedural time. CTA is an accurate diagnostic modality in detecting NVGIB. Performing abdomen and pelvis CTA before TAE improves the localization of gastrointestinal bleeding and facilitates embolization by reducing the overall procedural time. Impact of pre-angiography CTA on reducing the overall number of imaging studies, amount of contrast administered, and overall mortality and morbidity needs to be further investigated. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.070 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".