Role of colonoscopy in patients with unexplained melena: analysis of 53 patients

Tedesco, Francis J.; Pickens, Chip; Griffin, Joseph; Sivak, Michael; Sullivan, B.H.

doi:10.1016/s0016-5107(81)73226-7

Cited by 24 publications

(2 citation statements)

References 7 publications

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“…Previous studies have focused on the diagnostic yield of colonoscopy in the investigation of bleeding after a negative UGE; positivity rates of 23.5% to 30% were reported. The main limitations observed were overvaluing the role played by lesions with low implication for bleeding and small sample sizes . A recently published study with better design has reported a 14.2% positivity rate for colonoscopy (4.8% if only lesions with a high implication for bleeding are included) .…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal stromal tumor (GIST) mistaken for pancreatic pseudocyst – case report and literature review

Hansen

José

Caluz

2014

Clinical Case Reports

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Key Clinical MessageA 74-year-old female patient underwent a Roux-en-Y cystjejunostomy for pancreatic pseudocyst developed several melena episodes and she was surgically reappraised. The main diagnostic concern was a pancreatic cystic neoplasm. A 12 × 8.0 × 5.0 cm retro-gastric lesion was resected and pathology report indicated an unsuspected gastrointestinal stromal tumor (GIST). The report aimed to describe an atypical presentation of GIST.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal stromal tumor (GIST) mistaken for pancreatic pseudocyst – case report and literature review

Hansen

José

Caluz

2014

Clinical Case Reports

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“…1,4–6 This difference is mainly related to differing definitions of suspected bleeding sources that could produce melena. Prior studies described polyps ≥ 5 mm, 4,5 hemorrhoids, 6 or right-sided diverticula 1 as suspected sources of melena. However, we believe that small polyps are very unlikely to be a source of bleeding and that hemorrhoids or diverticula would present as hematochezia and not melena.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of colonoscopy to evaluate melena after a nondiagnostic EGD

Etzel

Williams

Jiang

et al. 2012

Gastrointestinal Endoscopy

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Background Melena can be caused by bleeding from lower GI sources. Colonoscopy is frequently used to investigate melena after a nondiagnostic EGD. Objective To determine the diagnostic yield and rate of therapeutic intervention during colonoscopy in patients with melena and a nondiagnostic EGD. Design Retrospective case-control study. Setting Community and academic centers over a diverse geographic area in the United States. Patients This study involved patients in the Clinical Outcomes Research Initiative database with a colonoscopy performed to investigate melena within 30 days of a nondiagnostic EGD for the same indication. A control group had colonoscopies performed for average-risk screening. Main Outcome Measurements The endoscopic finding of a suspected bleeding source defined as right-sided arteriovenous malformation, colitis, polyp 20 mm, tumor, or ulcer. Rate of therapeutic intervention during colonoscopy. Results Colonoscopy found a suspected bleeding source in 4.8% of patients with melena, more frequently than in the control group (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.65–2.86; P .0001). The rate of therapeutic intervention during melena-related colonoscopy was 1.7%. Patients with melena were more likely to have a colon tumor (OR 2.87; 95% CI, 1.82–5.51; P .0001) than were control patients. Limitations Retrospective design, conclusions being dependent on the accuracy of database input, and lack of pertinent clinical data (eg, hemoglobin). Conclusion The diagnostic yield of colonoscopy to investigate melena after nondiagnostic EGD is low. The need for therapeutic intervention during colonoscopy for this indication is very low. This population should undergo colonoscopy because they are at increased risk of colorectal cancer. Colonoscopy can potentially be performed electively in stable patients without continued bleeding.

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A study of patient acceptance of double-contrast barium enema and colonoscopy. Which procedure is preferred by patients?

Ness¹

1987

Archives of Internal Medicine

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Role of colonoscopy in patients with unexplained melena: analysis of 53 patients

Cited by 24 publications

References 7 publications

Gastrointestinal stromal tumor (GIST) mistaken for pancreatic pseudocyst – case report and literature review

Gastrointestinal stromal tumor (GIST) mistaken for pancreatic pseudocyst – case report and literature review

Diagnostic yield of colonoscopy to evaluate melena after a nondiagnostic EGD

A study of patient acceptance of double-contrast barium enema and colonoscopy. Which procedure is preferred by patients?

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