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Colonoscopy in GI Bleeding
Aka: Colonoscopy in GI Bleeding, Lower Endoscopy Evaluation of GI Bleeding, Lower GI Endoscopic Evaluation of Bleeding
- Indications
- Acute Lower Gastrointestinal Bleeding
- Protocol: Timing (Hospitalized patients)
- Colonoscopy within 12-48 hours
- Allows for adequate Bowel Preparation
- Allows for adequate Resuscitation
- Preparation
- Adequate Bowel Preparation is key to diagnosis
- Rapid Bowel Preparation in urgent Colonoscopy (colonic lavage with purge preparation)
- Uses Polyethylene glycol (PEG 3350, Golytely, Nulytely)
- Polyethylene glycol at 1 liter every 30-45 minutes for at least 2 hours until clear effluent OR
- Polyethylene glycol 4 to 6 Liters over 3-4 hours until output without stool or blood
- Diagnosis: Colonoscopy
- Pitfalls
- Definite bleeding source in suspected Diverticular Bleeding is only identified in 10-20% of cases
- However overall identifies 69-80% of Lower Gastrointestinal Bleeding causes
- High False Positive Rate for wrong site of bleeding
- Sites commonly misdiagnosed as bleeding source
- Diverticular Bleeding
- Angiodysplasia
- Criteria for definitive diagnosis of bleeding source
- Active bleeding
- Nonbleeding visible vessel or pigmented protuberance
- Clot adherent to bleeding source
- Fresh blood in a short colonic segment
- Diverticular ulceration with fresh blood nearby
- Signs: Colonoscopy findings on evaluation of Lower Gastrointestinal Bleeding
- Mucosal changes
- Infectious Colitis
- Ischemic Colitis
- Diverticular Bleeding source
- Management: Modalities for control of bleeding sites
- Thermal contact probe
- Nd-YAG Laser
- Dilute epinephine injection with electrocautery
- Band ligation or metallic clip placement
- References
- (1998) Gastrointest Endosc 48:685-88 [PubMed]
- Davila (2005) Gastrointest Endosc 62(5): 656-60 [PubMed]
- Fallah (2000) Med Clin North Am 84(5):1183-208 [PubMed]
- Jensen (2000) N Engl J Med 342(2): 78-82 [PubMed]
- Wilkins (2009) Am Fam Physician 80(9): 977-83 [PubMed]