Urgent Colonoscopy for Evaluation and Management of Acute Lower Gastrointestinal Hemorrhage: A Randomized Controlled Trial

Green, Bryan T.; Rockey, Don C.; Portwood, G.; Tarnasky, Paul R.; Guarisco, Steve; Branch, Malcolm S.; Leung, Joseph; Jowell, Paul S.

doi:10.1111/j.1572-0241.2005.00306.x

Cited by 301 publications

(153 citation statements)

References 22 publications

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“…Aggressive antegrade colonic irrigation (4-6 liters PEG solution in 3-4 h) in a prospective study versus an initial CT and angiographic diagnostic procedure for bleeding followed by elective colonoscopy resulted in the more frequent identification of bleeding lesions (42 vs. 22%), although this did not affect the prognosis [67]. …”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

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Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

127

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

“…In elderly patients with diverticula, diverticular bleeding is a cause of lower GI bleeding in up to 50% [67]. …”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

127

117

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“…CDB is characterized as arterial bleeding, which is caused by the rupture of vasa recta penetrating through diverticula [9]. So it is often massive and life threatening, for example, more than 50% of patients with CDB require blood transfusion [10] and its mortality ranges from 2 to 3% [10, 11]. Additionally, although most of CDB is often self-limited and it ceases spontaneously in 70–90% of cases [12, 13], recurrence of CDB is found in 13–47% of patients [10, 12, 14-18].…”

Section: Introductionmentioning

confidence: 99%

Initial Management of Colonic Diverticular Bleeding: Observational Study

et al. 2018

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Background/Aims: Although colonic diverticular bleeding (CDB) often ceases spontaneously, re-bleeding occurs in about 30%. Bleeding diverticulum can be treated directly by endoscopic hemostasis; however, it is difficult to perform colonoscopy in all cases with limited medical resource and certain risks. The aim of this study was to clarify who should undergo colonoscopy as well as appropriate methods of initial management in CDB patients. Methods: A total of 285 patients who were diagnosed as CDB and underwent colonoscopy from March 2004 to October 2015 were retrospectively analyzed. First, the association between re-bleeding and various factors including patients’ background and initial management were analyzed. Second, the examination conditions that influenced bleeding point identification were analyzed. Results: Of 285 patients, 187 were men and 98 were women. Median age was 75 years, and the median observation period was 17.5 months. Re-bleeding was observed in 79 patients (28%). A history of CDB (OR 2.1, p = 0.0090) and chronic kidney disease (CKD; OR 2.3, p = 0.035) were risk factors, and bleeding point identification (OR 0.20, p = 0.0037) was a preventive factor for re-bleeding. Bleeding point identification significantly reduced approximately 80% of re-bleeding. Furthermore, extravasation on CT (OR 3.7, p = 0.031) and urgent colonoscopy (OR 5.3, p < 0.001) were predictors for identification of bleeding point. Compared to bleeding point identification of 11% in all patients who underwent colonoscopy, identification rate in those who had extravasation on CT and underwent urgent colonoscopy was as high as 70%. Conclusions: Contrast-enhanced CT upon arrival is suggested, and patients with extravasation on CT would be good candidates for urgent colonoscopy, as well as patients who have a history of CDB and CKD.

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“…Smoot et al did not find a significant impact of the timing of urgent colonoscopy on the detection of active bleeding or non-bleeding signs in acute diverticular bleeding [36]. Similarly, Green et al randomized patients with LGIB to receive either urgent diagnostic and therapeutic colonoscopy or standard care involving labelled red blood cell scans and visceral angiography with vasopressin infusion [38]. The main outcomes analyzed by the study were mortality, length of hospital stay, length of intensive care unit stay, transfusion requirements, early and late rebleeding rates, and surgery, but no significant difference between the two groups was found.…”

Section: Colonoscopy and Diverticular Bleedingmentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

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Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

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Urgent Colonoscopy for Evaluation and Management of Acute Lower Gastrointestinal Hemorrhage: A Randomized Controlled Trial

Cited by 301 publications

References 22 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Initial Management of Colonic Diverticular Bleeding: Observational Study

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

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