ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding

Davila, Raquel E.; Rajan, Elizabeth; Adler, Douglas G.; Egan, James; Hirota, William K.; Leighton, Jonathan A.; Qureshi, Waqar; Zuckerman, Marc J.; Fanelli, Robert D.; Wheeler-Harbaugh, Jo; Baron, Todd H.; Faigel, Douglas O.

doi:10.1016/j.gie.2005.07.032

Cited by 137 publications

(70 citation statements)

References 47 publications

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“…Colonoscopy is often the first test performed as an approach to the diagnosis and treatment of LGIB. In the United States, endoscopy is recommended "in the early evaluation of severe acute LGIB" [1] . Use of oral antithrombotic drugs (ATDs) and non steroidal anti-inflammatory drugs (NSAIDs) is increasing with the aging of the population, and the number of patients with diseases causing LGIB is increasing [2,3] .…”

Section: Introductionmentioning

confidence: 99%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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AIM:To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH). METHODS:A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995(EG, -2006 n = 828) and a late group (LG, 2007(LG, -2013 Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.Informed consent statement: In this study, We do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies intended for people "taken from the human body undergoes No. 12 informed consent procedures was used samples not research". Information about the implementation of this research exposes to Fukuoka University Chikushi Hospital clinical research support Center home page. Conflict-of-interest statement:In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@ fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low. Retrospective Studybetween patients with and without DH. RESULTS:Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m 2 ), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION:Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients. Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inf...

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Section: Introductionmentioning

confidence: 99%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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“…However, the optimal diagnostic method for detecting LGIB is uncertain. The American Society for Gastrointestinal Endoscopy guidelines recommend the use of colonoscopy for the early evaluation of severe acute LGIB, although these criteria do not provide a definition of "early" (3). Hence, determining the optimal timing for colonoscopy remains an area of controversy (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

et al. 2015

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Objective We evaluated the diagnostic performance of computed tomography (CT) as an initial radiologic test for assessing the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding (LGIB) and investigated the effectiveness of contrast-enhanced (CE) CT for detecting colonic diverticular bleeding. Methods This was a retrospective study of 1,604 consecutive patients who visited or were referred to St. Marianna University Hospital due to acute LGIB and underwent colonoscopy within three months after presentation between September 2004 and December 2012. The clinicopathological data of the subjects were obtained from their medical records. Results Among the 1,604 patients presenting with LGIB, 879 (55%) underwent a CT scan. Elective colonoscopy was considered in cases in which typical colonic wall thickening was observed on CT, suggesting colonic inflammation or malignancy (239 patients; 27%). The diagnoses in the elective cases included ischemic colitis (38%), infectious colitis (8%), inflammatory bowel disease (8%) and malignancy (5%). Urgent colonoscopy was performed after the CT examination in 640 cases (73%). The most common presumptive CT diagnosis was diverticulum (402/640; 63%). Of the 638 patients who underwent CE-CT, diverticula were observed in 346 cases, including 104 cases of extravasation indicating ongoing diverticular bleeding. Among these 104 patients, the site of bleeding was identified in 71 subjects (68%) during colonoscopy. The rate of detection of the bleeding source on colonoscopy was significantly higher in the patients with extravasation on CE-CT than in those without extravasation on CE-CT (68% vs. 20%, respectively; p<0.001). Conclusion Urgent CT is useful for determining the optimal timing of colonoscopy in cases of acute LGIB. CE-CT may be used to depict the presence and location of active hemorrhage and provides useful information for subsequent colonoscopy, especially in patients with diverticular bleeding.

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“…[1] PR bleeding may be may be overt or occult, and overt bleeding can be acute, massive or chronic and covers both small bowel and colonic sources. [2] PR bleeding occurs in 20% of the population, but only about 7 per 1000 patients per year seek medical opinion for the same.…”

Section: Introductionmentioning

confidence: 99%

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

2017

IJSR

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Background & Objective: Per rectal (PR) bleeding is a common reason for hospitalization and is defined as bleeding thatemanates from a source distal to the ligament of Treitz. Although bleeding ceases spontaneously in 80% cases, 25% risk of re-bleed persists along with a difficulty of identifying the bleeding source. The purpose of this paper was to investigate the diagnostic yield of colonoscopy and assess the detection rate of different lesions in patients with PR bleeding as seen in our hospital. Methods: Fifty adult patients with PR bleed, irrespective of their gender were selected from general medical OPD and general medical wards. All patients were subjected to fibre-optic colonoscopy after necessary preparation and findings were recorded. Biopsies taken from suspected lesions were clinically indicated. Results: Study population included 50 patients, 28 males (56%) and 22 females (44%) with a mean age of 47.16±18.08 years. Findings at colonoscopy were; hemorrhoids (48%), polyp (6%), growth (6%), diverticular disease (6%), ulceration (4%), fissure (2%), fistula (2%), inflammatory bowel disease i.e., IBD (2%) and telangiectasia (2%). Normal findings were reported in 22% cases. Conclusion: Colonoscopy has very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum.

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ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding

Cited by 137 publications

References 47 publications

Increase in colonic diverticular hemorrhage and confounding factors

Increase in colonic diverticular hemorrhage and confounding factors

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

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

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