In Reply We appreciate the comments of Tulchinsky and of Dam and Kinney regarding our study1 comparing visceral angiography (VA) for lower gastrointestinal hemorrhage (LGIH) before and after implementation of evidence-based practice guidelines. These guidelines were developed by practitioners in conjunction with the Penn Center for Evidence-Based Practice based on existing (2008) medical literature to provide uniform, efficient, and safe care to patients with LGIH. Prior to 2008, wide institutional variability existed in LGIH management, and practitioners used combinations of several modalities (eg, colonoscopy, sulfur colloid and red blood cell [RBC] scans, VA, computed tomography [CT], or CT arteriography [CTA]).
Nadolski G, Jacovides CL, Pascual JL. Arteriography for Lower Gastrointestinal Hemorrhage—Reply. JAMA Surg. Published online November 30, 2016. doi:10.1001/jamasurg.2016.4262