The usefulness of transabdominal ultrasound for the diagnosis of lower gastrointestinal bleeding

Yamaguchi, Toshiki; Manabe, Noriaki; Hata, Jiro; Tanaka, Shinji; Haruma, Ken; Chayama, Kazuaki

doi:10.1111/j.1365-2036.2006.02883.x

Cited by 14 publications

(8 citation statements)

References 22 publications

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“…CT angiography is associated with radiation exposure and contrast nephropathy, but it can be an initial diagnostic choice when colonoscopy cannot readily be performed due to facility regulations or when patients with LGIB are intolerant to bowel preparation or examination itself [60,65]. Abdominal US has a lower diagnostic rate than that of colonoscopy, but because it does not require bowel preparation and is not associated with radiation exposure, this modality may be selected as an auxiliary diagnostic method to be used before colonoscopy [66].…”

Section: Quality Of Evidence: C Strength Of Recommendation: Probably mentioning

confidence: 99%

“…Quality of evidence: C Strength of recommendation: Do it Agreement rate: 100% Explanation Colonoscopy [58][59][60][61][62][63][64], CT, angiography, scintigraphy [59-61, 64, 65], and abdominal US [66] are commonly used for the diagnosis of acute LGIB and colonic diverticular bleeding. These modalities have been compared in observational studies [59][60][61]64] but not in a randomized controlled study.…”

Section: Quality Of Evidence: C Strength Of Recommendation: Probably mentioning

confidence: 99%

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

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Section: Quality Of Evidence: C Strength Of Recommendation: Probably mentioning

confidence: 99%

Section: Quality Of Evidence: C Strength Of Recommendation: Probably mentioning

confidence: 99%

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

et al. 2019

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“…Conversely, colonic wall thickening may indicate a significant pathology, such as ischemic colitis, inflammatory bowel disease or colorectal carcinoma (15,16). Although ultrasonographic examinations are useful for assessing the degree of colonic thickening, it is difficult to diagnose diverticular and/or rectal bleeding with this modality (11).…”

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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“…Case definitions of LGIB are included in Appendix 2 . A total of 11 studies included patients with LGIB of any cause 4 18 19 20 23 24 25 26 27 28 29 and four were limited to patients with diverticular bleeding 17 21 22 30 . The number of participants enrolled in each study ranged from 72 to 100 in the RCTs, and from 27 to 326 in the NRSIs.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

et al. 2017

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Background and study aims Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay. Patients and methods A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs). Results Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 – 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding. Conclusions In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.

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The usefulness of transabdominal ultrasound for the diagnosis of lower gastrointestinal bleeding

Abstract: SUMMARY BackgroundLower gastrointestinal bleeding is a frequent cause of hospitalization, but diagnostic methods for this condition are not fully established. Transabdominal ultrasound is a widely accepted diagnostic tool in bowel diseases.

Cited by 14 publications

References 22 publications

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

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

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

Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

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