Endoscopy 2019; 51(04): S216
DOI: 10.1055/s-0039-1681813
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Colon and rectum ePosters
Georg Thieme Verlag KG Stuttgart · New York

EFFICACY OF EMERGENCY ENDOSCOPIC HEMOSTASIS IN PATIENTS WITH ACUTE LOWER GASTROINTESTINAL BLEEDING AND FACTORS ASSOCIATED WITH NECESSITY OF ENDOSCOPIC INTERVENTION

G Diamantopoulou
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
C Konstantakis
2   Gastroenterology, General Hospital of Patras, Patras, Greece
,
C Tsolias
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
M Kalafateli
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
G Theocharis
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
G Skroubis
3   Surgery, University Hospital of Patras, Patras, Greece
,
C Triantos
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
K Papantoniou
1   Gastroenterology, University Hospital of Patras, Patras, Greece
,
K Thomopoulos
1   Gastroenterology, University Hospital of Patras, Patras, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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    Aims:

    The necessity and effectiveness of emergency endoscopic hemostasis in patients with acute lower gastrointestinal bleeding (ALGIB) has not been clearly established. The aim of this study was to define the role and efficacy of endoscopic hemostasis in patients with ALGIB and analyze factors associated with necessity for hemostasis.

    Methods:

    We analyzed the medical records of 587 patients with ALGIB treated in two affiliated hospitals during a seven year period. Our practice was to perform colonoscopy in all patients after hemodynamic stabilization during the first 24h of hospitalization and capsule enteroscopy and/or computed tomography angiography, when needed.

    Results:

    Endoscopic hemostasis was required in 96 patients (16.3%) and permanent hemostasis was achieved in 82 cases (85.4%) in first colonoscopy and in 100% after a second attempt. No patient required emergency surgical hemostasis and no patient died. Mainly clips (52%), adrenaline injection (40.6%) and APC (39.5%) were performed. Factors associated with need for endoscopic hemostasis were concomitant diseases (p = 0.035, OR 2.69, 95% Cl 1.05,6.87), use of anticoagulants (p < 0.001, OR 2.59, 95% CI 1.59, 4.22), post-polypectomy bleeding (p < 0.001, OR 23.01, 95% Cl11.92,44.26), presence of colonic ulcers (p < 0.001, OR 5.02, 95% Cl 2.14, 11.76) and vascular ectasias (p < 0.001, OR 46.37, 95% Cl 15.74,136.54). Ischemic colitis (p < 0.001, OR 0.766, 95% CI 0.729, 0.805), diverticulosis (p < 0.001, OR 0.108, 95% CI 0.034, 0.348) and neoplasia (p < 0.001, OR 0.89, 95% Cl 0.87, 0.92) were negative predictors for the need of endoscopic hemostasis.

    Conclusions:

    Endoscopic hemostasis is required in a substantial number of patients with ALGIB with high efficacy and its necessity can be predicted by a variety of factors. However larger prospective studies are required to better define a prognostic score.


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