Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis

Malik, Adnan; Inayat, Faisal; Goraya, Muhammad Hassan Naeem; Shahzad, Eman; Zaman, Maseeh uz

doi:10.1177/2324709621994383

Cited by 6 publications

(7 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of lower volume or alternative colon preparation solutions in the setting of LGIB has not been specifically addressed, but preliminary data appear encouraging [88][89][90]. A prospective study [91] used 2 L of PEG solution added to the water-jet tank, starting from the left side of the colon up to the cecum, in elderly patients (n = 33).…”

Section: S)mentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

View full text Add to dashboard Cite

Main Recommendations 1 ESGE recommends that the initial assessment of patients presenting with acute lower gastrointestinal bleeding should include: a history of co-morbidities and medications that promote bleeding; hemodynamic parameters; physical examination (including digital rectal examination); and laboratory markers. A risk score can be used to aid, but should not replace, clinician judgment.Strong recommendation, low quality evidence. 2 ESGE recommends that, in patients presenting with a self-limited bleed and no adverse clinical features, an Oakland score of ≤ 8 points can be used to guide the clinician decision to discharge the patient for outpatient investigation.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and no history of cardiovascular disease, a restrictive red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 7 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of 7–9 g/dL is desirable.Strong recommendation, low quality evidence. 4 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and a history of acute or chronic cardiovascular disease, a more liberal red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 8 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of ≥ 10 g/dL is desirable.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients with major acute lower gastrointestinal bleeding, colonoscopy should be performed sometime during their hospital stay because there is no high quality evidence that early colonoscopy influences patient outcomes.Strong recommendation, low quality of evidence. 6 ESGE recommends that patients with hemodynamic instability and suspected ongoing bleeding undergo computed tomography angiography before endoscopic or radiologic treatment to locate the site of bleeding.Strong recommendation, low quality evidence. 7 ESGE recommends withholding vitamin K antagonists in patients with major lower gastrointestinal bleeding and correcting their coagulopathy according to the severity of bleeding and their thrombotic risk. In patients with hemodynamic instability, we recommend administering intravenous vitamin K and four-factor prothrombin complex concentrate (PCC), or fresh frozen plasma if PCC is not available.Strong recommendation, low quality evidence. 8 ESGE recommends temporarily withholding direct oral anticoagulants at presentation in patients with major lower gastrointestinal bleeding.Strong recommendation, low quality evidence. 9 ESGE does not recommend withholding aspirin in patients taking low dose aspirin for secondary cardiovascular prevention. If withheld, low dose aspirin should be resumed, preferably within 5 days or even earlier if hemostasis is achieved or there is no further evidence of bleeding.Strong recommendation, moderate quality evidence. 10 ESGE does not recommend routinely discontinuing dual antiplatelet therapy (low dose aspirin and a P2Y12 receptor antagonist) before cardiology consultation. Continuation of the aspirin is recommended, whereas the P2Y12 receptor antagonist can be continued or temporarily interrupted according to the severity of bleeding and the ischemic risk. If interrupted, the P2Y12 receptor antagonist should be restarted within 5 days, if still indicated.Strong recommendation, low quality evidence.

show abstract

Section: S)mentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

View full text Add to dashboard Cite

show abstract

“…It is useful to know that other groups have experienced similar good results using very-low-volume bowel preparation for colonoscopy in acute LGIB 4 . These observations have also been taken into consideration in the latest ESGE guidelines 2 , in which this strategy has been labelled as “encouraging.” Therefore, it is highly desirable to continue sharing this expanding knowledge.…”

Section: Correctionmentioning

confidence: 99%

“…It is useful to know that other groups have experienced similar good results using very-low-volume bowel preparation for colonoscopy in acute LGIB [4].…”

mentioning

confidence: 99%

Acute lower gastrointestinal bleeding: crucial points in inpatient management for optimal urgent colonoscopy

Soriani

Biancheri

Hassan³

et al. 2021

Endosc Int Open

View full text Add to dashboard Cite

show abstract

“…Treatment modalities for evidence of GI bleed can vary based on intensity and location. Patients who are hemodynamically stable may just warrant observation and supportive care via IV fluids [ 4 ]. Although our patient was noted to have an upper GI bleed in the duodenum, most GI bleeds are secondary to diverticula in the lower GI tract; they can account for 20.8 to 41.6% of cases [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

To Bleed or Not to Bleed

Iskander¹,

Zaidi²,

Zheng³

et al. 2023

Cureus

View full text Add to dashboard Cite

The location of gastrointestinal (GI) bleeding can be characterized based on the characteristics of the bowel movements these patients present with. Bright red blood per rectum is usually associated with a lower bleed; if brisk and significant enough, however, upper bleeds can present similarly. Melenic or "tar-colored" bowel movements are more likely to occur from upper bleeds as the color is secondary to digestion of hemoglobin as it passes through the GI tract. At times, there can be a mix of the two which can make a clinical decision for intervention less obvious. To make matters more difficult, some of these patients can be on anticoagulation therapy for a myriad of reasons. Risks versus benefits at these times need to be weighed as holding this therapy may make the patients more prone to clotting while continuation would increase likelihood of bleeding. We present a case of a hypercoagulable patient who was started on rivaroxaban for history of pulmonary embolism; this led to the onset of an acute GI bleed from a duodenal diverticulum requiring endoscopic intervention. Although this can be a known effect of the therapy, the severity of bleed and changes in hemodynamics can warrant very different management strategies.

show abstract

Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis

Cited by 6 publications

References 36 publications

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Acute lower gastrointestinal bleeding: crucial points in inpatient management for optimal urgent colonoscopy

To Bleed or Not to Bleed

Contact Info

Product

Resources

About