The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center

Angtuaco, Teresita L.; Reddy, Sanjay; Drapkin, Sol; Harrell, Laura; Howden, Colin W.

doi:10.1111/j.1572-0241.2001.03871.x

Cited by 103 publications

(59 citation statements)

References 7 publications

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“…Acute LGIB stops spontaneously in 80-85 % of cases, and the overall mortality rate is around 10 % [3]. Localization is mostly performed by colonoscopy, but endoscopic therapeutic intervention is successful in only a minority of patients [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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Background Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.Methods From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. Conclusion In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

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Section: Introductionmentioning

confidence: 99%

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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“…The diagnostic and therapeutic benefits of GI endoscopy in the management of patients with inflammatory bowel disease, gastroesophageal reflux, and other conditions are well known [2][3][4][5]. There are few published data, however, concerning the diagnostic yield of GI endoscopy in children with IF.…”

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confidence: 99%

High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

Ching

Modi

Jaksic

et al. 2008

Journal of Pediatric Surgery

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Purpose-Children with intestinal failure (IF) often have gastrointestinal (GI) symptoms, including bleeding, increased stool output, and feeding intolerance. The use of endoscopic assessment of these symptoms has not been previously reported. This report evaluates the diagnostic yield of GI endoscopy in the setting of IF.Methods-After institutional review board approval, we reviewed the medical records (including endoscopy, pathology and microbiology data) of patients with IF who underwent GI endoscopies between September 1999 and March 2007.Results-Twenty-seven patients underwent 61 GI endoscopies: 34 esophagogastroduodenoscopies, 17 colonoscopies, 7 flexible sigmoidoscopies, and 3 ileoscopies. Indications for endoscopy, which were not mutually exclusive, included chronic diarrhea (39%, n = 24), GI bleeding (36%, n = 22), suspected bacterial overgrowth (36%, n = 22), and suspected peptic disease (15%, n = 9). Based on gross endoscopic appearance, histopathology, or microbiology, 43 (70%) procedures yielded abnormalities. These included infectious (20%, n = 12), anatomical (18%, n = 11), peptic (15%, n = 9), allergic (15%, n = 9), and other (2%, n = 1) findings. Eleven (73%) of 15 duodenal cultures grew a spectrum of 17 bacterial species. Overall, 24 (89%) of 27 patients had gross endoscopic, histopathologic, or microbiologic abnormalities. Conclusions-In

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“…Emergency endoscopy for lower gastrointestinal bleeding may be difficult because stool or blood in the colon may preclude adequate inspection of the mucosa. Although purging may clear retained blood and clots, active bleeding frequently quickly fills up the lumen and handicaps the examination [18]. Moreover, colonoscopy has to be deferred until patients are hemodynamically stable and have adequate colonic preparation [18].…”

Section: Discussionmentioning

confidence: 99%

“…Although purging may clear retained blood and clots, active bleeding frequently quickly fills up the lumen and handicaps the examination [18]. Moreover, colonoscopy has to be deferred until patients are hemodynamically stable and have adequate colonic preparation [18]. Finally, a source of bleeding in the small bowel (in all cases of gastrointestinal hemorrhage, 3-5% originate from the small intestine [19]) is poorly accessible to endoscopic investigations.…”

Section: Discussionmentioning

confidence: 99%

Treatment of gastrointestinal hemorrhage

et al. 2005

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Background: We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage. Methods: We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome. Results: Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization. Conclusion: Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instances.

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The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center

Cited by 103 publications

References 7 publications

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

Treatment of gastrointestinal hemorrhage

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