RSS-Feed abonnieren
DOI: 10.1055/s-1999-68
8. Appropriateness of Colonoscopy: Hematochezia [1]
Publikationsverlauf
Publikationsdatum:
31. Dezember 1999 (online)
![](https://www.thieme-connect.de/media/endoscopy/199908/lookinside/thumbnails/10.1055-s-1999-68-1.jpg)
Introduction
Lower GI bleeding (i. e. bleeding distal to the Treitz ligament) may be acute, chronic or occult. The most common causes cited in the literature vary greatly, in particular according to patient age. In acute bleeding, the large bowel should be investigated by anoscopy and sigmoidoscopy once the patient has been stabilized. If no potential source of bleeding is found, the entire colon should be investigated by colonoscopy. Colonoscopy is not only a diagnostic tool but also allows therapeutic intervention.
In chronic lower GI bleeding, it is essential to exclude colon cancer.
In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.
This article presents a literature review on hematochezia, that was provided to the panelists to study and comment prior to the panel meeting to support their ratings of appropriateness of use of colonoscopy. This article furthermore presents an overview of the main panel results related to hematochezia and a summary of published evidence and panel-based appropriateness criteria.
1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)
References
- 1 Vader J P, Burnand B, Froehlich F, et al. The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): Project and methods. Endoscopy. 1999; 31 572-578
- 2 Vader J P, Froehlich F, Dubois R W, et al. The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): Conclusions and WWW site. Endoscopy. 1999; 31 687-694
- 3 DeMarkles M P, Murphy J R. Acute lower gastrointestinal bleeding. Med Clin North Am. 1993; 77 1085-1100
- 4 American Society for Gastrointestinal Endoscopy. The Role of Endoscopy in the Patient with Lower Gastrointestinal Bleeding. Guidelines for clinical application. Gastrointest Endosc. 1988; 34 23-25S
- 5 Potter G D, Sellin J H. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. 1988; 17 341-356
- 6 Jensen D M, Machicado G A. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. 1988; 95 1569-1574
- 7 Bramley P N, Masson J W, McKnight G, et al. The role of an open-access bleeding unit in the management of colonic haemorrhage. A 2-year prospective study. Scan J Gastroenterol. 1996; 31 764-769
- 8 Richter J M, Christensen M R, Kaplan L M, Nishioka N S. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointest Endosc. 1995; 41 93-98
- 9 Makela J T, Kiviniemi H, Laitinen S, Kairaluoma M I. Diagnosis and treatment of acute lower gastrointestinal bleeding. Scan J Gastroenterol. 1993; 28 1062-1066
- 10 Colacchio T A, Forde K A, Patsos T J, Nunez D. Impact of modern diagnostic methods on the management of active rectal bleeding. Ten year experience. Am J Surg. 1982; 143 607-610
- 11 Rhee J C, Lee K T. The causes and management of lower GI bleeding: a study based on clinical observations at Hanyang University Hospital. Gastr Jap. 1991; 26 101-106
- 12 Vernava A M, Moore B A, Longo W E, Johnson F E. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997; 40 846-858
- 13 Leitman I M, Paull D E, Shires G T. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989; 209 175-180
- 14 Schrock T R. Colonoscopic diagnosis and treatment of lower gastrointestinal bleeding. Surg Clin N Am. 1989; 69 1309-1325
- 15 Rossini F P, Ferrari A, Spandre M, et al. Emergency colonoscopy. World J Surg. 1989; 13 190-192
- 16 Bokhari M, Vernava A M, Ure T, Longo W E. Diverticular hemorrhage in the elderly - is it well tolerated?. Dis Colon Rectum. 1996; 39 191-195
- 17 Brandt L J, Boley S J. The role of colonoscopy in the diagnosis and management of lower intestinal bleeding. Scand J Gastroenterol. 1984; 102 61-70
- 18 Dent O F, Goulston K J, Zubrzycki J, Chapuis P H. Bowel symptoms in an apparently well population. Dis Colon Rectum. 1986; 29 243-247
- 19 Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. Brit Med J. 1995; 311 486-488
- 20 Silman A J, Mitchell P, Nicholls R J, et al. Self-reported dark red bleeding as a marker comparable with occult blood testing in screening for large bowel neoplasms. Br J Surg. 1983; 70 721-724
- 21 Metcalf J V, Smith J, Jones R, Record C O. Incidence and causes of rectal bleeding in general practice as detected by colonoscopy. Brit J Gen Pract. 1996; 46 161-164
- 22 Helfand M, Marton K I, Zimmer-Gembeck M J, Sox H C Jr. History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up. J Am Med Ass. 1997; 277 44-48
- 23 Johnson M C. History is a poor predictor of source of minor rectal bleeding. Gastroenterology. 1993; 104 A12
- 24 Goulston K J, Cook I, Dent O F. How important is rectal bleeding in the diagnosis of bowel cancer and polyps?. Lancet. 1986; 2 261-265
- 25 Shinya H, Cwern M, Wolf G. Colonoscopic diagnosis and management of rectal bleeding. Surg Clin North Am. 1982; 62 897-903
- 26 Irvine E J, O'Connor J, Frost R A, et al. Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v. colonoscopy in rectal bleeding: barium enema v. colonoscopy in rectal bleeding. Gut. 1988; 29 1188-1193
- 27 Brenna E, Skreden K, Waldum H L, et al. The benefit of colonoscopy. Scan J Gastroenterol. 1990; 25 81-88
- 28 Hixson L J, Sampliner R E, Chernin M, et al. Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding. Eur J Radiol. 1989; 9 254-257
- 29 Rex D K, Weddle R A, Lehman G A, et al. Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding. Gastroenterology. 1990; 98 855-861
- 30 Acosta J A, Fournier T K, Knutson C O, Ragland J J. Colonoscopic evaluation of rectal bleeding in young adults. Am Surg. 1994; 60 903-906
- 31 Kind S. Investigation of the optimal work-up of bright red blood per rectum (BRBPR): Ages 35 - 49. Gastroenterology. 1993; 104 A14
- 32 Graham D J, Pritchard T J, Bloom A D. Colonoscopy for intermittent rectal bleeding: impact on patient management. J Surg Res. 1993; 54 136-139
- 33 Guillem J G, Forde K A, Treat M R, et al. The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding. Ann Surg. 1987; 206 606-611
- 34 Richter J M. Occult gastrointestinal bleeding. Gastroenterol Clin N Am. 1994; 23 53-66
- 35 Zuckerman G, Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol. 1992; 87 62-66
1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)
Prof. Jean-Jacques Gonvers
Policlinique Médicale Universitaire
Rue César-Roux 19
CH-1005 Lausanne
Switzerland
Telefon: + 41-21-3452323
eMail: Jean-Jacques.Gonvers@inst.hospvd.ch