Emergency colonoscopy

Rossini, Francesco Paolo; Ferrari, A; Spandre, M.; Cavallero, M; Gemme, Carlo; Loverci, Carlo; Bertone, A.; Pintor, Marco Pinna

doi:10.1007/bf01658398

Cited by 83 publications

(45 citation statements)

References 30 publications

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“…Although the incidence of severe colonic bleeding is relatively low, it occurs most often in older people who suffer from concomitant medical problems [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Patients with massive lower intestinal bleeding are often placed under careful observation and given transfusions because spontanous recovery often occurs.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding

Ohyama

Sakurai²,

Ito³

et al. 2000

Digestion

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Background: Three hundred and forty-five patients who underwent urgent colonoscopy for acute hematochezia during the past 20 years (from 1976 to 1995) were retrospectively analyzed. Methods: Urgent colonoscopy was defined as endoscopy performed within 24 h after a bleeding episode. Preparation was initially minimal with a water or glycerine enema. Recently, however, polyethylene glycol is used. Results: The overall diagnostic accuracy for bleeding site detection was 89.1% (307 cases). Successful insertion was made to the ileocecal region in 193 cases (55.9%). The disease most frequently discoverd by urgent colonoscopy was transient ischemic colitis (62 cases). Negative urgent colonoscopy specimens (18 cases) were later diagnosed by other methods as being small intestinal bleeding foci. In 10 cases, initial colonoscopy failed to detect the bleeding foci. Endoscopic hemostasis was performed in 48 cases. Permanent hemostasis succeeded in 32 cases (66.7%). Complications of urgent colonoscopy were fever after the examination (22 cases) and hypotension during endoscopy (7 cases). Conclusion: Urgent colonoscopy is considered to be a safe and useful examination for acute lower gastrointestinal bleeding and hemostasis.

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Section: Discussionmentioning

confidence: 99%

“…It was formerly thought that urgent colonoscopy for severe hematochezia is dangerous, and often nondiagnostic and impractical. Recent progress, however, in the development of instruments and techniques has overcome the limits of urgent colonoscopy [6, 7]. The procedure is also feasible with adequate prior colonic cleaning [8].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding

Ohyama

Sakurai²,

Ito³

et al. 2000

Digestion

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“…The diagnostic accuracy of urgent colonoscopy is about 69% (range from 40-90%) in acute lower GI bleeding (Jensen 1988, Rossini 1989, Peura 1997, Zuckerman 1998. Early colonoscopy reduces hospital stay and costs (Strate 2003, Machicado 1997.…”

Section: Colonoscopymentioning

confidence: 99%

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

2017

International Journal of Research Studies in Medical and Health

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ABSTRACT:Acute lower Gastro intestinal bleeding is a relatively common problem in the emergency department. Etiology is diverse as is the degree of bleeding and natural history. Hence there are a number of subtle aspects of clinical assessment, investigations and management which require attention and application fr optimal outcomes. The goal of this review is to highlight the practical issues in managing the condition from the perspective of a medical officer or a junior resident in surgery who is on-call in the emergency department. A working algorithm incorporating the key management issues is also presented.

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“…Consequently, the value of urgent colonoscopy remains controversial [156][157][158][159] . Although there have been reports concerning colonoscopy for acute lower bleeding in which no oral preparation was given, it is now widely accepted that oral preparation plus early colonoscopy achieves better diagnostic and therapeutic performance [157,160,161] . Moreover, there is risk of explosion when electrocautery is used in patients with unprepared colons, as about 50% of patients have potentially explosive concentrations of hydrogen and methane [162,163] .…”

Section: Pediatric Patientsmentioning

confidence: 99%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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Emergency colonoscopy

Cited by 83 publications

References 30 publications

Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding

Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

Achieving the best bowel preparation for colonoscopy

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