Endoscopic Management of Lower Gastrointestinal Hemorrhage

Abstract

Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency. Colonoscopy is the initial diagnostic and therapeutic procedure for most patients with LGIB. The optimal timing of colonoscopy is uncertain, but earlier examinations are associated with higher diagnostic yield. In patients with severe bleeding, colonoscopy should be performed within 24 hours of presentation after an adequate orally administered colon preparation. Additional washing during colonoscopy and careful inspection should be performed to identify high-risk stigmata. Endoscopic therapy should be attempted if high-risk bleeding stigmata are identified. The endoscopic treatment modality depends on the bleeding source, location, operator expertise, and the need for ongoing anticoagulation or antiplatelet therapy. This review 5 tables, 5 figures, and 50 references. Keywords: argon plasma coagulation, clipping, colonoscopy, diverticular bleeding, endoscopic band ligation, endoscopic hemostasis, postpolypectomy bleeding, stigmata of recent hemorrhage, vascular ectasias