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Management of gastrointestinal bleeding induced by gastrointestinal endoscopy
1Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA.
Insights
Therapeutic endoscopy poses a higher risk of gastrointestinal bleeding than diagnostic procedures. Meticulous technique and prompt hemostatic therapy are crucial for managing immediate and delayed bleeding events.
Area of Science:
- Gastroenterology
- Endoscopic procedures
Background:
- Therapeutic gastrointestinal endoscopy carries a significantly higher risk of inducing gastrointestinal hemorrhage compared to diagnostic endoscopy.
- Specific high-risk procedures include colonoscopic polypectomy, endoscopic biliary sphincterotomy, and variceal therapy.
Purpose of the Study:
- To highlight the increased risk of hemorrhage associated with therapeutic gastrointestinal endoscopy.
- To outline management strategies for immediate and delayed post-endoscopic bleeding.
Main Methods:
- Comparative analysis of bleeding risks between diagnostic and therapeutic endoscopic procedures.
- Review of hemostatic techniques for managing endoscopic hemorrhage.
Main Results:
- Colonoscopic polypectomy has a 1.6% bleeding risk, versus 0.02% for diagnostic colonoscopy.
- Hemorrhage can be immediate or delayed, requiring timely endoscopic intervention.
Conclusions:
- Meticulous endoscopic technique is key to reducing hemorrhage risk.
- Immediate bleeding requires prompt endoscopic hemostatic therapy; delayed bleeding necessitates repeat endoscopy for diagnosis and treatment.
Abstract:
Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonoscopic polypectomy has a risk of approximately 1.6% of inducing bleeding, compared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher-risk procedures include colonoscopic polypectomy, endoscopic biliary sphincterotomy, endoscopic dilatation, endoscopic variceal therapy, percutaneous endoscopic gastrostomy, and endoscopic sharp foreign body retrieval. The risk of inducing hemorrhage is decreased by meticulous endoscopic technique. Hemorrhage from endoscopy may be immediate or delayed. Immediate hemorrhage should be immediately treated by endoscopic hemostatic therapy, including injection therapy, thermocoagulation, or electrocoagulation. Delayed hemorrhage generally requires repeat endoscopy for diagnosis and for therapy, using the same hemostatic techniques.