Multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: when, why and how?

Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. According to current gastroenterological guidelines, esophagogastroduodenoscopy (EGD) represents the first-line modality for both diagnosis and treatment of NVUGIB. As opposed to lower gastrointestinal bleeding, multidetector-row computed tomography angiography (MDCTA) has a limited and no well-established role in the diagnostic process of NVUGIB. However, gastroenterological guidelines mainly focus on peptic-related NVUGIB only. Moreover, the adoption of MDCTA in NVUGIB has recently been encountered in radiological guidelines for special situations. Areas covered: The aim of our study was to comprehensively review and discuss the current and potential indications of MDCTA and its technical aspects in the diagnostic process of NVUGIB. A comprehensive literature search of PubMed, EMBASE, and Google Scholar databases was conducted through May 2025 to identify pertinent studies. Expert opinion: Although EGD undoubtedly represents the cornerstone in both diagnosis and treatment of most NVUGIB cases, MDCTA has emerged as a promising adjunct diagnostic tool, especially among clinically severe cases and those due to rare, non-peptic sources. However, evidence is still scarce, and further studies are needed to clarify its role in this scenario.