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Clin Colon Rectal Surg 2010; 23(1): 031-036
DOI: 10.1055/s-0030-1247855
© Thieme Medical Publishers

Endoscopic Treatment for Lower Gastrointestinal Bleeding

Charles B. Whitlow1
  • 1Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
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Publication History

Publication Date:
09 March 2010 (online)

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ABSTRACT

Lower gastrointestinal bleeding is common and can result from several colonic causes including diverticulosis, arteriovenous malformations, ischemia, inflammatory bowel disease, infectious colitis, neoplasm, postpolypectomy, and anastomotic and radiation proctitis. Following resuscitation and evaluation, colonoscopy can be used for diagnosis and treatment. Most physicians prescribe a bowel preparation for their patients. Therapeutic options include injection, coagulation (monopolar or bipolar cautery, argon plasma coagulator), and mechanical (clips, bands, detachable loops) devices.

KEYWORDS

Gastrointestinal bleeding - hemorrhage - colonoscopy - endoscopy

REFERENCES

  • 1 Longstreth G F. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.  Am J Gastroenterol. 1997;  92(3) 419-424
    PubMedGoogle Scholar
  • 2 Strate L L. Lower GI bleeding: epidemiology and diagnosis.  Gastroenterol Clin North Am. 2005;  34(4) 643-664
    CrossrefPubMedGoogle Scholar
  • 3 Jensen D M, Machicado G A. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge.  Gastroenterology. 1988;  95(6) 1569-1574
    CrossrefPubMedGoogle Scholar
  • 4 Hoedema R E, Luchtefeld M A. The management of lower gastrointestinal hemorrhage.  Dis Colon Rectum. 2005;  48(11) 2010-2024
    CrossrefPubMedGoogle Scholar
  • 5 Chaudhry V, Hyser M J, Gracias V H, Gau F C. Colonoscopy: the initial test for acute lower gastrointestinal bleeding.  Am Surg. 1998;  64(8) 723-728
    PubMedGoogle Scholar
  • 6 Jensen D M, Machicado G A, Jutabha R, Kovacs T O. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.  N Engl J Med. 2000;  342(2) 78-82
    CrossrefPubMedGoogle Scholar
  • 7 Davila R E, Rajan E, Adler D G Standards of Practice Committee et al. ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding.  Gastrointest Endosc. 2005;  62(5) 656-660
    CrossrefPubMedGoogle Scholar
  • 8 Pilichos C, Bobotis E. Role of endoscopy in the management of acute diverticular bleeding.  World J Gastroenterol. 2008;  14(13) 1981-1983
    CrossrefPubMedGoogle Scholar
  • 9 Ohyama T, Sakurai Y, Ito M, Daito K, Sezai S, Sato Y. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.  Digestion. 2000;  61(3) 189-192
    CrossrefPubMedGoogle Scholar
  • 10 Pescatore P, Jornod P, Borovicka J et al.. Epinephrine versus epinephrine plus fibrin glue injection in peptic ulcer bleeding: a prospective randomized trial.  Gastrointest Endosc. 2002;  55(3) 348-353
    CrossrefPubMedGoogle Scholar
  • 11 Rutgeerts P, Rauws E, Wara P et al.. Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer.  Lancet. 1997;  350(9079) 692-696
    CrossrefPubMedGoogle Scholar
  • 12 Jensen D M, Machicado G A, Hirabayashi K. Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers.  Gastrointest Endosc. 2006;  64(5) 768-773
    CrossrefPubMedGoogle Scholar
  • 13 Shin E J, Ko C W, Magno P et al.. Comparative study of endoscopic clips: duration of attachment at the site of clip application.  Gastrointest Endosc. 2007;  66(4) 757-761
    CrossrefPubMedGoogle Scholar
  • 14 Tucker L E. Diverticular bleeding: novel treatment with band ligation.  Mo Med. 2004;  101(1) 61-63
    PubMedGoogle Scholar
  • 15 Farrell J J, Graeme-Cook F, Kelsey P B. Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study.  Endoscopy. 2003;  35(10) 823-829
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Green B T, Rockey D C, Portwood G et al.. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial.  Am J Gastroenterol. 2005;  100 2395-2402
    CrossrefPubMedGoogle Scholar
  • 17 Anastassiades C P, Baron T H, Wong Kee Song L M. Endoscopic clipping for the management of gastrointestinal bleeding.  Nat Clin Pract Gastroenterol Hepatol. 2008;  5(10) 559-568
    CrossrefPubMedGoogle Scholar
  • 18 Patel C, Song L, Buttar N et al.. Effectiveness of endoscopic hemoclipping for diverticular bleeding (abstract).  Gastrointest Endosc. 2006;  63 AB200
    PubMedGoogle Scholar
  • 19 Simpson P W, Nguyen M H, Lim J K, Soetikno R M. Use of endoclips in the treatment of massive colonic diverticular bleeding.  Gastrointest Endosc. 2004;  59(3) 433-437
    CrossrefPubMedGoogle Scholar
  • 20 Yen E F, Ladabaum U, Muthusamy V R, Cello J P, McQuaid K R, Shah J N. Colonoscopic treatment of acute diverticular hemorrhage using endoclips.  Dig Dis Sci. 2008;  53(9) 2480-2485
    CrossrefPubMedGoogle Scholar
  • 21 Perez R O, Sousa Jr A, Bresciani C et al.. Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage.  Tech Coloproctol. 2007;  11(1) 64-66
    CrossrefPubMedGoogle Scholar
  • 22 Martínez-Serrano M A, Parés D, Pera M et al.. Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis.  Tech Coloproctol. 2009;  13(1) 49-53
    CrossrefPubMedGoogle Scholar
  • 23 Malik A H, East J E, Buchanan G N, Kennedy R H. Endoscopic haemostasis of staple-line haemorrhage following colorectal resection.  Colorectal Dis. 2008;  10(6) 616-618
    CrossrefPubMedGoogle Scholar
  • 24 Fatima H, Rex D K. Minimizing endoscopic complications: colonoscopic polypectomy.  Gastrointest Endosc Clin N Am. 2007;  17(1) 145-156, viii
    CrossrefPubMedGoogle Scholar
  • 25 Kouklakis G, Mpoumponaris A, Gatopoulou A et al.. Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.  Surg Endosc. 2009;  23(12) 2732-2737
    CrossrefPubMedGoogle Scholar
  • 26 Watabe H, Yamaji Y, Okamoto M et al.. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors.  Gastrointest Endosc. 2006;  64(1) 73-78
    CrossrefPubMedGoogle Scholar
  • 27 Rex D K, Lewis B S, Waye J D. Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage.  Gastrointest Endosc. 1992;  38(2) 127-129
    CrossrefPubMedGoogle Scholar
  • 28 Baillie J. Postpolypectomy bleeding.  Am J Gastroenterol. 2007;  102(6) 1151-1153
    CrossrefPubMedGoogle Scholar
  • 29 Parra-Blanco A, Kaminaga N, Kojima T et al.. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding.  Gastrointest Endosc. 2000;  51(1) 37-41
    CrossrefPubMedGoogle Scholar
  • 30 Uno Y, Satoh K, Tuji K et al.. Endoscopic ligation by means of clip and detachable snare for management of colonic postpolypectomy hemorrhage.  Gastrointest Endosc. 1999;  49(1) 113-115
    CrossrefPubMedGoogle Scholar
  • 30a Silva R A, Mesquita N, Dinis-Ribeiro M et al.. Fibrin glue for postpolypectomy hemorrhage.  J Clin Gastroenterol. 2003;  37 193
    CrossrefPubMedGoogle Scholar
  • 31 Green B T, Rockey D C. Lower gastrointestinal bleeding—management.  Gastroenterol Clin North Am. 2005;  34(4) 665-678
    CrossrefPubMedGoogle Scholar
  • 32 Sebastian S, O'Connor H, O'Morain C, Buckley M. Argon plasma coagulation as first-line treatment for chronic radiation proctopathy.  J Gastroenterol Hepatol. 2004;  19(10) 1169-1173
    CrossrefPubMedGoogle Scholar
  • 33 Andreyev H J. Argon plasma coagulation in chronic radiation proctitis: Postgate et al.  Endoscopy. 2007;  39(8) 751-752, author reply 752
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Karamanolis G, Triantafyllou K, Tsiamoulos Z et al.. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis.  Endoscopy. 2009;  41(6) 529-531
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Nürnberg D, Pannwitz H, Burkhardt K D, Peters M. Gas explosion caused by argon plasma coagulation of colonic angiodysplasias.  Endoscopy. 2007;  39(Suppl 1) E182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Manner H, Plum N, Pech O, Ell C, Enderle M D. Colon explosion during argon plasma coagulation.  Gastrointest Endosc. 2008;  67(7) 1123-1127
    CrossrefPubMedGoogle Scholar
  • 37 Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract.  Best Pract Res Clin Gastroenterol. 2008;  22(2) 313-328
    CrossrefPubMedGoogle Scholar
  • 38 Olmos J A, Marcolongo M, Pogorelsky V, Herrera L, Tobal F, Dávolos J R. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia.  Dis Colon Rectum. 2006;  49(10) 1507-1516
    CrossrefPubMedGoogle Scholar
  • 39 Dumortier J, Scoazec J-Y, Ponchon T. Treatment of refractory ulcerative proctitis with argon plasma coagulation: case report.  Gastrointest Endosc. 2004;  60(2) 317-319
    CrossrefPubMedGoogle Scholar

Charles B WhitlowM.D. 

Department of Colon and Rectal Surgery

Ochsner Clinic Foundation, New Orleans, LA 70121

Email: cwhitlow@ochsner.org