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Lower GI bleeding: a review of current management, controversies and advances
Andrew J Moss1, Hussein Tuffaha2, Arshad Malik3
1Department of Surgery, Peterborough City Hospital, Peterborough, Cambridgeshire, PE3 9GZ, UK.
Insights
Most acute lower gastrointestinal (GI) bleeding cases resolve conservatively. For persistent bleeding, colonoscopy is the first-line treatment, followed by angiography or surgery if endoscopic and radiological interventions fail.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Lower gastrointestinal (GI) bleeding, defined as bleeding distal to the ligament of Treitz, accounts for approximately 3% of all UK surgical referrals.
- Effective management strategies are crucial for this common and potentially serious condition.
Purpose of the Study:
- To review current evidence on the management of lower gastrointestinal bleeding.
- To provide an overview of aetiology, clinical assessment, and treatment options for continuous bleeding.
Main Methods:
- A narrative review of literature was conducted.
- Searches were performed on Medline, Pubmed, and Cochrane databases by two researchers.
Main Results:
- Conservative management is effective for most acute lower GI bleeding cases.
- Colonoscopy is the primary investigation and treatment for ongoing bleeding.
- Angiography with superselective embolisation or surgical intervention are options for refractory cases.
Conclusions:
- Further research is needed for reliable mortality and rebleeding prediction tools.
- Combination therapies involving angiography, endoscopy, and surgery show promise.
- Haemostatic agents offer an additional endoscopic management option for difficult bleeding situations.
Purpose:
Lower gastrointestinal (GI) bleeding is defined as bleeding distal to the ligament of Treitz. In the UK, it represents approximately 3 % of all surgical referrals to the hospital. This review aims to provide review of the current evidence regarding the management of this condition.
Methods:
Literature was searched using Medline, Pubmed, and Cochrane for relevant evidence by two researchers. This was conducted in a manner that enabled a narrative review of the evidence covering the aetiology, clinical assessment and management options of continuously bleeding patients.
Findings:
The majority of patients with acute lower GI bleeding can be treated conservatively. In cases where ongoing bleeding occurs, colonoscopy is still the first line of investigation and treatment. Failure of endoscopy and persistent instability warrant angiography, possibly preceded by CT angiography and proceeding to superselective embolisation. Failure of embolisation warrants surgical intervention.
Conclusions:
There are still many unanswered questions. In particular, the development of a more reliable predictive tool for mortality, rebleeding and requirement for surgery needs to be the ultimate priority. There are a small number of encouraging developments on combination therapy with regard to angiography, endoscopy and surgery. Additionally, the increasing use of haemostatic agents provides an additional tool for the management of bleeding endoscopically in difficult situations.
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