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Related Experiment Videos

Investigative modalities for massive lower gastrointestinal bleeding.

Aayad R Al Qahtani1, Richard Satin, Jerry Stern

  • 1Division of Colorectal Surgery, Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, Quebec H3T 1E2, Canada.

World Journal of Surgery
|July 5, 2002
PubMed
Summary

Colonoscopy is the most effective diagnostic tool for lower gastrointestinal bleeding, surpassing scans and angiography. However, a definitive diagnosis remains elusive in 35% of patients with massive lower GI bleeding.

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Area of Science:

  • Gastroenterology
  • Diagnostic Imaging
  • Medical Efficacy Studies

Background:

  • Massive lower gastrointestinal bleeding presents a diagnostic challenge.
  • Evaluating the effectiveness of various diagnostic methods is crucial for patient management.
  • Understanding the etiology and localization of bleeding impacts treatment decisions.

Purpose of the Study:

  • To assess the diagnostic efficacy of multiple modalities for massive lower gastrointestinal bleeding.
  • To compare the effectiveness of sigmoidoscopy, colonoscopy, scintigraphy, angiography, and barium enemas.
  • To identify the most common causes of lower gastrointestinal bleeding in the studied population.

Main Methods:

  • Retrospective chart review of 136 patients admitted for lower gastrointestinal bleeding over 25 years.

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  • Data collection included demographics, comorbidities, medications, blood transfusion requirements, and diagnostic procedures.
  • Analysis of diagnostic yield and localization accuracy for rigid/flexible sigmoidoscopy, colonoscopy, scintigraphy, angiography, and barium enemas.

    • Main Results:

    • Colonoscopy achieved a specific diagnosis in 45% of cases, significantly higher than sigmoidoscopy (2.9-11.0%).
    • Scintigraphy and angiography showed lower efficacy in localizing bleeding sites compared to colonoscopy.
    • Diverticulosis (52 patients) and angiodysplasia (14 patients) were the most frequent causes; 35% of cases remained undiagnosed.

    Conclusions:

    • Colonoscopy is a superior diagnostic modality for lower gastrointestinal bleeding compared to scintigraphy and angiography.
    • Despite comprehensive investigations, a definitive diagnosis for lower gastrointestinal bleeding could not be established in a significant proportion of patients.
    • The need for operative intervention was lower than reported in previous studies, suggesting effective conservative management or spontaneous cessation of bleeding.