Jejunal diverticula bleeding: A challenging diagnosis entity

Table 2 Diagnostic modalities in lower gastrointestinal bleeding

Diagnostic modality	Advantages	Disadvantages	Cost-effectiveness
Colonoscopy[2]	Diagnostic and therapeutic tool	Requires bowel preparation Limited in massive active bleeding	High cost-effectiveness due to therapeutic capability
Flexible sigmoidoscopy[3]	Rapid bedside evaluation; minimal preparation	Limited to distal colon	Only in selected cases with suspected distal anorectal pathology
CTA[3]	More widely available and better accuracy in identifying the bleeding site with almost 100% accuracy; high sensitivity (79%-95%) and specificity (95%-100%)	Requires contrast; risk of nephropathy; contrast dye allergic reaction; non-therapeutic	High as initial imaging before angiography or surgery
Catheter angiography[2,3]	Diagnostic[18] and therapeutic; identifies the bleeding source in 25%-70% of the cases	Invasive; risk of bowel ischemia (30%)	Moderate
Technetium-99m-tagged red blood[1] cell scintigraphy[2,3]	Reveals intermittent bleeding Non-invasive	Low spatial resolution; may not precisely locate accurate bleeding site	Moderate
Video capsule endoscopy[2]	Non-invasive diagnostic alternative that allows the entire small bowel to be explored in 79%-90%	Only diagnostic; risk of capsule retention in 2% of patients undergoing study for small bowel bleeding	Low
Barium small bowel study[2]	Identifies structural abnormalities	Low sensitivity in active bleeding	Low

CTA: Computed tomography angiography.