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Related Experiment Videos

Colonoscopy: the initial test for acute lower gastrointestinal bleeding

V Chaudhry1, M J Hyser, V H Gracias

  • 1Department of Surgery, Saint Francis Hospital, Evanston, Illinois, USA.

The American Surgeon
|August 11, 1998
PubMed
Summary
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Emergency colonoscopy is a safe and effective tool for diagnosing and treating acute lower gastrointestinal bleeding. This study shows high success rates in identifying bleeding sources and performing interventions, making it a primary diagnostic choice.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Emergency Medicine

Background:

  • Literature indicates emergency colonoscopy is safe and accurate for acute lower gastrointestinal (LGI) bleeding.
  • Surgical literature, however, suggests challenges in performing this procedure during acute bleeding events.

Purpose of the Study:

  • To evaluate the safety and efficacy of early, unprepped colonoscopy within 24 hours for diagnosing and treating acute LGI bleeding.
  • To establish early colonoscopy as a primary investigative method in the surgical management of LGI bleeding.

Main Methods:

  • Retrospective analysis of 85 consecutive patients with suspected LGI bleeding undergoing urgent, unprepped colonoscopy by surgical endoscopists.
  • Inclusion criteria: passage of blood per rectum distal to the ligament of Treitz, excluding hemoccult-positive or upper GI sources.

Related Experiment Videos

  • Therapeutic interventions included Nd:YAG laser or BICAP coagulation for active bleeding.

    • Main Results:

    • The source of bleeding was identified in 97% of patients (82/85).
    • Predominant bleeding sources included diverticulosis (20%), ischemic colitis (18%), hemorrhoids (14%), and arteriovenous malformations (11%).
    • Endoscopic control of active hemorrhage was achieved in 17/27 acutely bleeding patients, with a low complication rate (0.8%) and in-hospital mortality (3.5%).

    Conclusions:

    • Early, unprepped colonoscopy is a highly accurate and safe diagnostic tool for acute lower gastrointestinal bleeding.
    • Colonoscopic intervention offers significant therapeutic capabilities for controlling active hemorrhage.
    • This procedure is recommended as the initial diagnostic test of choice for acute LGI hemorrhage in experienced hands.