Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review

Abstract

Rectal bleeding is a known complication of transrectal ultrasound-guided prostate biopsy. It is usually mild and resolves spontaneously. However, massive life-threatening hemorrhage can also rarely occur in this setting, potentially presenting a therapeutic conundrum. We hereby delineate the case of a patient who experienced severe intermittent lower gastrointestinal bleeding following a transrectal ultrasound-guided prostate biopsy. Traditional tamponade methods failed to control the hemorrhage. Subsequently, an urgent flexible sigmoidoscopy revealed an anterior rectal wall prominence with biopsy punctures as the possible source of bleeding. Endoclip was successfully applied at the bleeding site, achieving permanent hemostasis. The patient had an uneventful recovery and was discharged from the hospital. While the use of endoclipping has been widely reported in gastrointestinal endoscopy, its application remains exceedingly rare in this group of patients. To our knowledge, this case represents only the third report of endoclipping alone to treat massive rectal bleeding follwing a prostate biopsy procedure. In addition, we systematically review published medical literature to evaluate endoscopic techniques aimed at managing this important complication. This article illustrates that endoscopic therapy may present an efficient, noninvasive method to deal with severe post-biopsy rectal hemorrhage. Therefore, prompt consultation with the gastroenterology service should be advocated.

Delayed-onset bleeding after transrectal prostate biopsy presenting as a rectal Dieulafoy’s lesion

“…ing after transrectal prostate biopsy [5]. In addition, this case highlights the importance of early endoscopic intervention to improve the patient's outcome in such cases.…”

“…The mucosal defect created by the biopsy needle might have caused the exposure of the underlying submucosal artery to the rectal lumen. A recent case-based systematic review reported the efficacy of endoscopic therapy for severe bleeding after transrectal prostate biopsy 5 . In addition, this case highlights the importance of early endoscopic intervention to improve the patient’s outcome in such cases.…”

Hemorrhagic Shock After Transrectal Ultrasound-Guided Prostate Biopsy Successfully Treated With Endoscopic Therapy

“…Given post-TRUS-guided biopsy bleeding is rare and often managed by urologists, not much data have been reported to establish the superiority of monotherapy compared with combination endoscopic management. 5 …”

“…Given post-TRUS-guided biopsy bleeding is rare and often managed by urologists, not much data have been reported to establish the superiority of monotherapy compared with combination endoscopic management. 5 Several factors have been identified to increase the risk of post-TRUS-guided biopsy bleeding. Patients with a rich vascular bed surrounding the rectum and prostate, which are supplied from the inferior vesicular arteries, the middle and inferior rectal arteries, and dense submucosal venous plexus, could be at higher risk of bleeding.…”

Editorial Comment: Proctoscopy following transrectal prostate biopsy can control rectal bleeding after prostate biopsy

“…If proctoscopy is routinely performed when hemostasis is difficult, it may be helpful to predict the site of bleeding without proctoscopy. In addition to endoclipping, endoscopic therapeutic techniques include injection sclerotherapy, thermocoagulation, band ligation, and combination therapies 3 . Because urologists do not usually perform the above endoscopic therapies, assistance from a gastrointestinal endoscopist or colorectal surgeon should be required when endoscopic therapy is necessary.…”