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[Lower digestive hemorrhage. Its etiology and the diagnostic efficacy of different explorations. A study of 2646
J Maté Jiménez1, R Castaños Mollor-Penalva, J García-Samaniego Rey
1Servicio de Gastroenterología, Hospital de La Princesa, Universidad Autónoma de Madrid.
Insights
Lower gastrointestinal bleeding (LGB) is common but difficult to diagnose. Total colonoscopy is effective in locating over 92% of bleeding sources, with hemorrhoids being the most frequent cause.
Area of Science:
- Gastroenterology
- Coloproctology
- Diagnostic Imaging
Background:
- Lower gastrointestinal bleeding (LGB) presents a diagnostic challenge despite its higher frequency compared to upper gastrointestinal bleeding (UGB).
- Understanding the common causes and diagnostic yield of various endoscopic and imaging techniques is crucial for effective patient management.
Purpose of the Study:
- To retrospectively analyze the diagnostic accuracy of different methods in identifying the source of lower gastrointestinal bleeding.
- To determine the most common causes and locations of LGB in a large patient cohort.
Main Methods:
- Retrospective review of 8544 patient cases admitted to a Coloproctology Unit.
- Analysis of diagnostic procedures including sigmoidoscopy, total colonoscopy, fiber gastroscopy, barium studies, arteriography, and radionuclide bleeding scans.
- Categorization of bleeding sources, patient demographics, and diagnostic success rates.
Main Results:
- Hemorrhoids were the most frequent cause of LGB (48.5%), with bleeding originating from the anus in 61% of cases.
- Total colonoscopy successfully localized the bleeding source in 92.7% of patients.
- When total colonoscopy was non-diagnostic, fiber gastroscopy identified the source in 1.5% of all cases.
Conclusions:
- The descending colon is a common site for hemorrhagic lesions.
- Total colonoscopy is the primary diagnostic tool for LGB, achieving high localization rates.
- Alternative methods have limited diagnostic utility when colonoscopy fails to identify the bleeding source.
Abstract:
Lower gastrointestinal bleeding (LGB) is more frequent than upper gastrointestinal bleeding (UGB) with a better course and a more difficult diagnosis. We reviewed retrospectively 8544 cases from patients who were admitted at the Coloproctology Unit of Hospital de la Princesa. Those with the diagnosis of LGB with visible blood in stools (2646-31%) were outpatients, with a mean age of 43 years (range 9-91). Males represented 56.4% and females 43.6. All of them underwent at least sigmoidoscopic examination. The more frequent disorder was hemorrhoids (48.5%) and the bleeding source was found in the anus in 61%. Most of lesions (86%) could be reached with the short colonoscope and 92.7% of the bleeding sources were found with total colonoscopy. In 7.3% colonoscopy was not diagnostic and fiber gastroscopy identified the bleeding spot in 1.5% of the total. Barium studies were diagnostic in 0.5%, arteriography in 0.25% and radionuclide bleeding scan in 0.1%. Finally in 130 patients the bleeding source could not be found. We conclude that most of hemorrhagic lesions occur in the descending colon and that total colonoscopy can localize more than 92%. When total colonoscopy fails only 33% of the lesions can be found (2.35% from total) and 19% (1.5% from the total number) with UGB are identified with the fiber gastroscopic examination.