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
Further Information

Publication History

Publication Date:
09 March 2010 (online)

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.

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
  • 2 Strate L L. Lower GI bleeding: epidemiology and diagnosis.  Gastroenterol Clin North Am. 2005;  34(4) 643-664
  • 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
  • 4 Hoedema R E, Luchtefeld M A. The management of lower gastrointestinal hemorrhage.  Dis Colon Rectum. 2005;  48(11) 2010-2024
  • 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
  • 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
  • 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
  • 8 Pilichos C, Bobotis E. Role of endoscopy in the management of acute diverticular bleeding.  World J Gastroenterol. 2008;  14(13) 1981-1983
  • 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
  • 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
  • 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
  • 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
  • 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
  • 14 Tucker L E. Diverticular bleeding: novel treatment with band ligation.  Mo Med. 2004;  101(1) 61-63
  • 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
  • 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
  • 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
  • 18 Patel C, Song L, Buttar N et al.. Effectiveness of endoscopic hemoclipping for diverticular bleeding (abstract).  Gastrointest Endosc. 2006;  63 AB200
  • 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
  • 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
  • 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
  • 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
  • 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
  • 24 Fatima H, Rex D K. Minimizing endoscopic complications: colonoscopic polypectomy.  Gastrointest Endosc Clin N Am. 2007;  17(1) 145-156, viii
  • 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
  • 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
  • 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
  • 28 Baillie J. Postpolypectomy bleeding.  Am J Gastroenterol. 2007;  102(6) 1151-1153
  • 29 Parra-Blanco A, Kaminaga N, Kojima T et al.. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding.  Gastrointest Endosc. 2000;  51(1) 37-41
  • 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
  • 30a Silva R A, Mesquita N, Dinis-Ribeiro M et al.. Fibrin glue for postpolypectomy hemorrhage.  J Clin Gastroenterol. 2003;  37 193
  • 31 Green B T, Rockey D C. Lower gastrointestinal bleeding—management.  Gastroenterol Clin North Am. 2005;  34(4) 665-678
  • 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
  • 33 Andreyev H J. Argon plasma coagulation in chronic radiation proctitis: Postgate et al.  Endoscopy. 2007;  39(8) 751-752, author reply 752
  • 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
  • 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
  • 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
  • 37 Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract.  Best Pract Res Clin Gastroenterol. 2008;  22(2) 313-328
  • 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
  • 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

Charles B WhitlowM.D. 

Department of Colon and Rectal Surgery

Ochsner Clinic Foundation, New Orleans, LA 70121

Email: cwhitlow@ochsner.org

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