Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding

Abstract

Background: Three hundred and forty-five patients who underwent urgent colonoscopy for acute hematochezia during the past 20 years (from 1976 to 1995) were retrospectively analyzed. Methods: Urgent colonoscopy was defined as endoscopy performed within 24 h after a bleeding episode. Preparation was initially minimal with a water or glycerine enema. Recently, however, polyethylene glycol is used. Results: The overall diagnostic accuracy for bleeding site detection was 89.1% (307 cases). Successful insertion was made to the ileocecal region in 193 cases (55.9%). The disease most frequently discoverd by urgent colonoscopy was transient ischemic colitis (62 cases). Negative urgent colonoscopy specimens (18 cases) were later diagnosed by other methods as being small intestinal bleeding foci. In 10 cases, initial colonoscopy failed to detect the bleeding foci. Endoscopic hemostasis was performed in 48 cases. Permanent hemostasis succeeded in 32 cases (66.7%). Complications of urgent colonoscopy were fever after the examination (22 cases) and hypotension during endoscopy (7 cases). Conclusion: Urgent colonoscopy is considered to be a safe and useful examination for acute lower gastrointestinal bleeding and hemostasis.

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

“…The frequencies of unexpected adverse events attributable to oral lavage agents do not differ significantly between acute LGIB and non-GI bleeding [75], and bowel preparation has been shown to facilitate the accurate diagnosis of disease and SRH (see CQ13) and enable endoscopic treatment [62]. On the other hand, the rate of reaching the cecum was not high, in the range of 20-70%, among patients who had colonoscopy in the early phase without bowel preparation with oral lavage solution [76][77][78][79], and 6.4% of the patients (22/345) developed fever after colonoscopy [79]. Two retrospective observational studies have investigated the difference in cecal intubation rates between bowel preparation with oral lavage solutions and other bowel preparation methods (e.g., enema) [76,78] and reported a higher rate with the former [76,78].…”

Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature

“…The sequence of gastroscopy or colonoscopy depends on the patient's clinical symptoms. [9][10][11] Although an urgent colonoscopy performed within 6 h is able to identify the source of bleeding more frequently in patients with LGIB, the urgent colonoscopy does not differ from elective colonoscopy in terms of mortality rates, the duration of hospital stay, the need for transfusions, early and late re-bleeding rates, and the need for surgical treatment. 4 Eleven percent of upper gastrointestinal bleedings are manifested clinically by hematochezia, therefore a gastroscopy should proceed in severe hematochezia to rule out upper gastrointestinal bleeding.…”

Diagnostic Yield of Colonoscopy in Patients Presenting with Per Rectum Bleeding at a Tertiary Care Centre

“…In the literature, colonoscopy within 8 hours, 12 hours and 24 hours are all reported as urgent colonoscopies. [14] Green etal showed no difference in mortality, hospital stay, mean transfusion requirements, early or late re-bleeding or surgery when comparing urgent colonoscopy (within 8 hours) to standard medical care (without colonoscopy but include angiography). [19]However, two other studies found that earlier colonoscopy (within 24 hours) was associated with shorter hospital stay [15,20] .In addition, Strate et al found that earlier colonoscopy resulted on significantly more therapeutic interventions.…”

“…[11][12][13] However, in the only randomized controlled trial on the use of urgent colonoscopy for evaluation of acute PR bleeding, 42% of patients had a definite diagnosis made when colonoscopy was performed within 8 hours of admission. [14] …”