Related Experiment Video
Updated: Feb 21, 2026
Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review
Kathryn Oakland1, Jennifer Isherwood2, Conor Lahiff3
1NHS Blood and Transplant, Oxford, United Kingdom.
Insights
Early colonoscopy improves diagnosis and therapy for lower gastrointestinal bleeding (LGIB), reducing hospital stays. More high-quality research is needed to confirm optimal investigation strategies for LGIB.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Interventional Radiology
Background:
- Lower gastrointestinal bleeding (LGIB) management involves various diagnostic and therapeutic interventions.
- The optimal sequence and utility of these investigations remain unclear.
- Key investigations include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic yields of endoscopy, CTA, and angiography in managing LGIB.
- To assess the impact of these interventions on rebleeding rates, blood transfusion requirements, and hospital length of stay.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, PubMed, EMBASE, CENTRAL) for randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs).
- Studies published between 2000 and November 2015 involving hospitalized patients with LGIB were included.
- Meta-analyses were performed using pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs).
Main Results:
- Limited high-quality evidence exists; few studies directly compared interventions or investigated optimal timing.
- Meta-analysis of nonrandomized studies indicated higher diagnostic and therapeutic yields for early colonoscopy (within 24 hours) compared to later procedures.
- Early colonoscopy was associated with a reduced hospital length of stay but did not significantly impact rebleeding or transfusion rates.
Conclusions:
- There is a significant lack of high-quality evidence guiding the management of LGIB.
- The available data suggest that early colonoscopy may enhance diagnostic and therapeutic outcomes in LGIB patients.
- Further rigorous research is warranted to establish definitive best practices for LGIB investigation and treatment.
Background And Study Aims:
Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay.
Patients And Methods:
A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs).
Results:
Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 - 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding.
Conclusions:
In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: