Advertisement

Urgent colonoscopy for acute lower-GI bleeding

  • Grace H Elta
    Correspondence
    Reprint requests: Grace H. Elta, MD, 3912 Taubman Center, Ann Arbor, MI 48109-0362.
    Affiliations
    Current affiliations: Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan USA
    Search for articles by this author
      Lower-GI (LGI) bleeding is defined as bleeding distal to the ligament of Treitz. The annual incidence of LGI bleeding is estimated to be 20 to 27 cases per 100,000 adult population at risk.
      • Longstreth G.F
      Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
      When patients hospitalized for GI bleeding are identified, LGI sources account for a quarter to a third of all bleeding events.
      • Peura D.A
      • Lanza F.L
      • Gostout C.J
      • Foutch P.G
      The American College of Gastroenterology Bleeding Registry: preliminary findings.
      Lower-GI bleeding is more common in men than in women, and the incidence rate increases with age, with a greater than 200-fold increase from the 3rd to the 9th decades of life.
      • Longstreth G.F
      Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
      The mortality rate for LGI bleeding is reported at 3.6% and, similar to upper-GI (UGI) bleeding, mortality is markedly higher in patients who begin bleeding after hospitalization.
      • Longstreth G.F
      Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
      In contrast to UGI bleeding, patients with LGI bleeding are less likely to present with shock and to have lower transfusion requirements. Similar to UGI bleeding, spontaneous cessation of bleeding occurs in approximately 80% of cases.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Longstreth G.F
        Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
        Am J Gastroenterol. 1997; 92: 419-424
        • Peura D.A
        • Lanza F.L
        • Gostout C.J
        • Foutch P.G
        The American College of Gastroenterology Bleeding Registry: preliminary findings.
        Am J Gastroenterol. 1997; 92: 924-928
        • Zuckerman G.R
        • Prakash C
        Acute lower intestinal bleeding.
        Gastrointest Endosc. 1998; 48: 606-617
        • Jensen D.M
        • Machicado G.A
        Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge.
        Gastroenterology. 1988; 95: 1569-1574
        • Cuellar R.E
        • Gavaler J.S
        • Alexander J.A
        • Brouillette D.W
        • Chien M.C
        • Yoo Y.K
        • et al.
        Gastrointestinal tract hemorrhage: the value of a nasogastric aspirate.
        Arch Int Med. 1990; 150: 1381-1384
        • O'Neill B.B
        • Gosnell J.E
        • Lull R.J
        • Schecter W.P
        • Koch J
        • Halvorsen R.A
        • et al.
        Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding.
        Arch Surg. 2000; 135: 1076-1081
        • Voeller G.R
        • Bunch G
        • Britt L.G
        Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage.
        Surgery. 1991; 110: 799-804
        • Koval G
        • Benner K.G
        • Rosch J
        • Kozak B.E
        Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage.
        Dig Dis Sci. 1987; 32: 248-253
        • Gomes A.S
        • Lois J.F
        • McCoy R.D
        Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization.
        AJR Am J Roentgenol. 1986; 146: 1031-1037
        • Sherman L.M
        • Shenoy S.S
        • Cerra F.B
        Selective intra-arterial vasopressin: clinical efficacy and complications.
        Ann Surg. 1979; 189: 298-302
        • Guy G.E
        • Shetty P.C
        • Sharma R.P
        • Burke M.W
        • Burke T.H
        Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles.
        AJR Am J Roentgenol. 1992; 159: 521-526
        • DeBarros J
        • Rosas L
        • Cohen J
        • Vignati P
        • Sardella W
        • Hallisey M
        The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolization.
        Dis Colon Rectum. 2002; 45: 802-808
        • Farner R
        • Lichliter W
        • Kuhn J
        • Fisher T
        Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding.
        Am J Surg. 1999; 178: 587-591
        • Renzulli P
        • Maurer C.A
        • Netzer P
        • Dinkel H.P
        • Buchler M.W
        Subtotal colectomy with primary ileorectostomy is effective for unlocalized, diverticular hemorrhage.
        Langenbecks Arch Surg. 2002; 387: 67-71
        • Baker R
        • Senagore A
        Abdominal colectomy offers safe management for massive lower GI bleeding.
        Am Surg. 1994; 8: 578-581
        • Strate L.L
        • Syngal S
        Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding.
        Am J Gastroenterol. 2003; 98: 317-322
        • Chaudhry V
        • Hyser M.J
        • Gracias V.H
        • Gau F.C
        Colonoscopy: the initial test for acute lower gastrointestinal bleeding.
        Am Surg. 1998; 64: 723-728
        • Jensen D.M
        • Machicado G.A
        • Jutabha R
        • Kovacs T.O
        Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.
        N Engl J Med. 2000; 342: 78-82
        • ASGE Technology Committee
        ASGE technology status evaluation: endoscopic tattooing.
        Gastrointest Endosc. 2002; 55: 811-814
        • Kim Y
        • Marcon N.E
        Injection therapy for colonic diverticular bleeding: a case report.
        J Clin Gastroenterol. 1993; 17: 46-48
        • Hokama A
        • Uehara T
        • Nakayoshi T
        • Uezu Y
        • Tokuyama K
        • Kinjo F
        • et al.
        Utility of endoscopic hemoclipping for colonic diverticular bleeding.
        Gastrointest Endosc. 1997; 92: 543-546
        • Zuckerman G.R
        • Prakash C
        Acute lower intestinal bleeding.
        Gastrointest Endosc. 1999; 49: 228-238
        • Kewenter J
        • Hellzen-Ingemarsson A
        • Kewenter G
        • Olsson U
        Diverticular disease and minor rectal bleeding.
        Scand J Gastroenterol. 1985; 20: 922-924
        • McGuire Jr., H.H
        Bleeding colonic diverticula. A reappraisal of natural history and management.
        Ann Surg. 1994; 220: 653-656
        • Ramirez F.C
        • Johnson D.A
        • Zierer A.T
        • Walker G.J
        • Sanowski R.A
        Successful endoscopic hemostasis of bleeding colonic diverticula with epinephrine injection.
        Gastrointest Endosc. 1996; 43: 167-170
        • Savides T.J
        • Jensen D.M
        Colonoscopic hemostasis for recurrent diverticular hemorrhage associated with a visible vessel: a report of three cases.
        Gastrointest Endosc. 1994; 40: 70-73
        • Foutch P.G
        • Zimmerman K
        Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention.
        Am J Gastroenterol. 1996; 91: 2589-2593
        • Prakash C
        • Chokshi H
        • Walden D.T
        • Aliperti G
        Endoscopic hemostasis in acute diverticular bleeding.
        Endoscopy. 1999; 31: 460-463
        • Johnston J.J
        • Sones J
        Endoscopic heater probe coagulation of the bleeding colonic diverticulum.
        Gastrointest Endosc. 1986; 84 ([abstract]): AB168
        • Ohyama T
        • Sakuri Y
        • Ito M
        • Daito K
        • Sezai S
        • Sato Y
        Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.
        Digestion. 2000; 61: 189-192
        • Pardi D.S
        • Loftus E.V
        • Tremaine W.J
        • Sandborn W.J
        • Alexander G.L
        • Balm R.K
        • et al.
        Acute major gastrointestinal hemorrhage in inflammatory bowel disease.
        Gastrointest Endosc. 1999; 49: 153-157
        • Belaiche J
        • Lousi E
        • D'Haens G
        • Cabooter M
        • Naegel S
        • De Vos M
        • et al.
        Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients.
        Am J Gastroenterol. 1999; 94: 2177-2181
        • Viggiano T.R
        • Zighelborn J
        • Ahlguist D.A
        • Goustout C.J
        • Wang K.K
        • Larson M.V
        Endoscopic Nd:YAG laser coagulation of bleeding from radiation proctopathy.
        Gastrointest Endosc. 1993; 39: 513-517
        • Taylor J.G
        • Dijario J.A
        • Buchi K.N
        Argon laser therapy for hemorrhagic radiation proctitis: long term results.
        Gastrointest Endosc. 1993; 39: 641-644
        • Jensen D.M
        • Machicado G.A
        • Cheng S
        • Jensen M.G
        • Jutabha R
        A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia.
        Gastrointest Endosc. 1997; 45: 20-25
        • Taylor J.G
        • DiSario J.A
        • Bjorkman D.J
        KTP laser therapy for bleeding from chronic radiation proctopathy.
        Gastrointest Endosc. 2000; 52: 353-357
        • Richter J.M
        • Hedberg S.E
        • Athanasoulis C.A
        • Schapiro R.H
        Angiodysplasia. Clinical presentation and colonoscopic diagnosis.
        Dig Dis Sci. 1984; 29: 481-485
        • Boley S.J
        • Sammartano R
        • Brandt L.J
        • Sprayregen S
        Vascular ectasias of the colon.
        Surg Gynecol Obstet. 1979; 149: 353-359
        • Rogers R.H
        Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular and pulmonary disease.
        Gastrointest Endosc. 1980; 26: 134-138
        • Junquera F
        • Quiroga S
        • Saperas E
        • Perez-Lafuente M
        • Videla S
        • Alvarez-Castells A
        Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia.
        Gastroenterology. 2000; 119: 293-299
        • Brandt L.J
        • Spinnell M.K
        Ability of naloxone to enhance the colonoscopic appearance of normal colon vasculature and colon vascular ectasias.
        Gastrointest Endosc. 1999; 49: 79-83
        • Cello J.P
        • Grendell J.H
        Endoscopic laser treatment for gastrointestinal vascular ectasias.
        Ann Intern Med. 1986; 104: 352-354
        • Santos J.C.M
        • Apilli F
        • Guimaraes A.S
        • Rocha D
        Angiodysplasia of the colon: endoscopic diagnosis and treatment.
        Br J Surg. 1988; 75: 256-258
        • Hutcheon D.F
        • Kablin J
        • Bulkley G.B
        • Smith G.W
        Effect of therapy on bleeding rates in gastrointestinal angiodysplasia.
        Am J Surg. 1987; 53: 6-9
        • Aldabagh S.M
        • Trujillo Y.P
        • Taxy J.B
        Utility of specimen angiography in angiodysplasia of the colon.
        Gastroenterology. 1986; 91: 725-729
        • Sorbi D
        • Norton I
        • Conio M
        • Balm R
        • Zinsmeister A
        • Gostrout C.J
        Postpolypectomy lower GI bleeding: descriptive analysis.
        Gastrointest Endosc. 2000; 51: 690-696
        • Parra-Blanco A
        • Kaminaga N
        • Kojima T
        • Endo Y
        • Uragami N
        • Okawa N
        • et al.
        Hemoclipping for postpolypectomy and postbiopsy colonic bleeding.
        Gastrointest Endosc. 2000; 51: 37-41
        • Schoenfeld P.S
        • Guyatt G
        • Hamilton F
        • Laine L
        • Cook D
        • Bjorkman D
        • et al.
        An evidence-based approach to gastroenterology diagnosis.
        Gastroenterology. 1999; 116: 1230-1237
        • Eisen G.M
        • Dominitz J.A
        • Faigel D.O
        • Goldstein J.L
        • Kalloo A.N
        • Petersen B.T
        • et al.
        An annotated algorithmic approach to acute lower gastrointestinal bleeding.
        Gastrointest Endosc. 2001; 53: 859-863
        • Zuccaro Jr., G
        Management of the adult patient with acute lower gastrointestinal bleeding.
        Am J Gastroenterol. 1998; 93: 1202-1208
        • Gordon R.L
        • Ahl K.L
        • Kerlan R.K
        • Wilson M.W
        • LaBerge J.M
        • Sandhu J.S
        • et al.
        Selective arterial embolization for the control of lower gastrointestinal bleeding.
        Am J Surg. 1997; 174: 24-28
        • Bloomfeld R.S
        • Rockey D.C
        • Shetzline M.A
        Endoscopic therapy of acute diverticular hemorrhage.
        Am J Gastroenterol. 2001; 96: 2367-2372
        • Angtuaco T.L
        • Reddy S.K
        • Drapkin S
        • Harrell L.E
        • Howden C.W
        The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center.
        Am J Gastroenterol. 2001; 96: 1782-1785