Procedure

Colonoscopy in GI Bleeding

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Colonoscopy in GI Bleeding, Lower Endoscopy Evaluation of GI Bleeding, Lower GI Endoscopic Evaluation of Bleeding

  • Protocol
  • Timing (Hospitalized patients)
  1. Colonoscopy within 12-48 hours
    1. Allows for adequate Bowel Preparation
    2. Allows for adequate Resuscitation
  • Preparation
  1. Adequate Bowel Preparation is key to diagnosis
  2. Rapid Bowel Preparation in urgent Colonoscopy (colonic lavage with purge preparation)
    1. Polyethylene glycol at 1 liter every 30-45 minutes for at least 2 hours until clear effluent
  1. Pitfalls
    1. Definite bleeding source in suspected Diverticular Bleeding is only identified in 10-20% of cases
      1. However overall identifies 69-80% of Lower Gastrointestinal Bleeding causes
    2. High False Positive Rate for wrong site of bleeding
    3. Sites commonly misdiagnosed as bleeding source
      1. Diverticular Bleeding
      2. Angiodysplasia
  2. Criteria for definitive diagnosis of bleeding source
    1. Active bleeding
    2. Nonbleeding visible vessel or pigmented protuberance
    3. Clot adherent to bleeding source
    4. Fresh blood in a short colonic segment
    5. Diverticular ulceration with fresh blood nearby
  • Management
  • Modalities for control of bleeding sites
  1. Thermal contact probe
  2. Nd-YAG Laser
  3. Epinephine injection with electrocautery
  4. Band ligation or metallic clip placement