TITLE

The Utility of Urgent Colonoscopy in the Evaluation of Acute Lower Gastrointestinal Tract Bleeding: A 2-Year Experience From a Single Center

AUTHOR(S)
Angtuaco, Terence L.; Reddy, Sanjay K.; Drapkin, Sol; Harrell, Laura E.; Howden, Colin W.
PUB. DATE
June 2001
SOURCE
American Journal of Gastroenterology;Jun2001, Vol. 96 Issue 6, p1782
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: Urgent colonoscopy is often recommended to evaluate acute rectal bleeding. However, it may not identify a source because of blood in the lumen or inadequate preparation. Our aim was to determine the utility of urgent colonoscopy as the initial test for acute rectal bleeding. METHODS: This was a retrospective chart review of all patients discharged in 1997 and 1998 with an International Classification of Diseases, 9th Revision, code for hematochezia or rectal bleeding. RESULTS: We identified 514 charts but excluded 424 because of inaccurate coding. In the 90 with confirmed acute rectal bleeding, colonoscopy was the initial test in 39; age, sex, and race distributions were similar to those who did not have colonoscopy. A definite source of bleeding was seen at colonoscopy in only three patients, a probable source in 26, and no source in 10. Therapeutic intervention in four patients with a definite or probable source was successful in three. The commonest reasons for not performing urgent colonoscopy were bleeding from presumed hemorrhoids or bleeding that was clinically insignificant. Spontaneous resolution of bleeding and length of hospital stay were not affected by urgent colonoscopy. Five patients had surgery for unrelated reasons. In-hospital mortality was 2% and was unrelated to bleeding. CONCLUSION: Urgent colonoscopy as the initial investigation in acute lower GI tract bleeding probably does not alter the outcome in most cases. Identification of a definite bleeding source leading to successful therapeutic intervention is rare. Spontaneous resolution is frequent, length of hospital stay is similar, and clinical outcome is excellent regardless of whether or not urgent colonoscopy is performed.
ACCESSION #
17636859

 

Related Articles

  • Urgent Colonoscopy for Evaluation and Management of Acute Lower Gastrointestinal Hemorrhage: A Randomized Controlled Trial. Green, Bryan T.; Rockey, Don C.; Portwood, G.; Tarnasky, Paul R.; Guarisco, Steve; Branch, Malcolm S.; Leung, Joseph; Jowell, Paul // American Journal of Gastroenterology;Nov2005, Vol. 100 Issue 11, p2395 

    OBJECTIVES: We hypothesized that early intervention in patients with lower gastrointestinal bleeding (LGIB) would improve outcomes and therefore conducted a prospective randomized study comparing urgent colonoscopy to standard care. METHODS: Consecutive patients presenting with LGIB without...

  • Detection of Bleeding Due to Small Bowel Cholesterol Emboli Using Helical CT Examination in Gastrointestinal Bleeding of Obscure Origin. Miller, Frank H.; Kline, Mitchell J.; Vanagunas, Arvydas D. // American Journal of Gastroenterology;Dec1999, Vol. 94 Issue 12, p3623 

    Chronic, intermittent GI bleeding is defined as obscure when routine diagnostic examinations of the GI tract, including barium and endoscopic studies, fail to reveal the cause of bleeding. Our patient had significant bleeding and extensive evaluation including upper endoscopy, small bowel...

  • AIR CONTRAST BARIUM ENEMA VERSUS COLONOSCOPY: THE DEBATE CONTINUES. Noyer, Charles; Simon, Douglas; Johnson, David A.; Cattau Jr., Edward L. // American Journal of Gastroenterology;Sep1991, Vol. 86 Issue 9, p1274 

    Comments on a study which examined the cost effectiveness and diagnostic yield of colonoscopy and flexible sigmoidoscopy with air contrast barium enema in patients with suspected lower gastrointestinal bleeding. Drawbacks of the study; Issues in considering the choice between endoscopic and...

  • Evaluating Rectal Bleeding in Young Persons. Sadovsky, Richard // American Family Physician;5/15/2002, Vol. 65 Issue 10, p2131 

    Presents information on a study by J.D. Lewis and others that assessed the cost-effectiveness of a variety of evaluation strategies in young patients with asymptomatic rectal bleeding. Description of the study and its results; Conclusion that based on a cost-effectiveness analysis rectal...

  • DELAYED POSTPOLYPECTOMY BLEEDING. Singaram, Chandar; Torbey, Camille F.; Jacoby, Russell F. // American Journal of Gastroenterology;Jan1995, Vol. 90 Issue 1, p146 

    Complications of colonoscopic polypectomy include perforation, infection, and bleeding. The incidence of bleeding; after polypectomy is reported to range from one to seven per 1000 polypectomies. This complication usually occum within a few days after the standard procedure using bipolar...

  • Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding. Chun-Che Lin; Yi-Chia Lee; Huei Lee; Jaw-Town Lin; Wei-Chi Ho; Tan-Hsia Chen; Hsiu-Po Wang // Intensive Care Medicine;May2005, Vol. 31 Issue 5, p743 

    Objective:To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding.Design and setting:A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in...

  • The Iatrogenic Complications of Colonoscopic Polypectomy: A Multicenter Retrospective Study. Min Ho Choi; Yun Sun Choi; Chan Soo So; Woon Geon Shin; Kyoung Oh Kim; Hyun Joo Jang; Cheol Hee Park; Kyung Ho Kim; Jin Bae Kim; Il Hyun Baek; Kwang Ho Baik; Sea Hyub Kae; Hak Yang Kim // Intestinal Research;2013, Vol. 11 Issue 1, p46 

    Background/Aims: Colonoscopic polypectomy is an effective tool for the treatment of colonic polyps. With the recent widespread use of colonoscopic polypectomy, there is a growing concern about iatrogenic complications, such as bleeding and perforation. The aim of this study is to analyze the...

  • Diverticular Bleeding and the Pigmented Protuberance (Sentinel Clot): Clinical Implications, Histopathological Correlation, and Results of Endoscopic Intervention. Foutch, P. Gregory; Zimmerman, Kent // American Journal of Gastroenterology;Dec1996, Vol. 91 Issue 12, p2589 

    Over a 3-yr period, we performed colonoscopy on five patients (mean age 71 yr) in whom a specific diverticulum that contained a pigmented protuberance (PiP) was unequivocally identified as the cause for hemorrhage. Four of these individuals had endoscopic bipolar cauterization of the PiP, and...

  • The Role of Endoscopy in Managing Acute Lower Gastrointestinal Bleeding. Gostout, Christopher J. // New England Journal of Medicine;01/13/2000, Vol. 342 Issue 2, p125 

    Editorial. Offers observations about the study by Jensen et al. The use of colonoscopy performed on an urgent basis for the diagnosis and treatment of acute hemorrhage from colonic diverticulosis; Uncertainty of the timing of colonoscopy and the best type of endoscopic therapy; Suggestions...

Share

Read the Article

Courtesy of your local library

Public Libraries Near You (See All)
Looking for a Different Library?

Other Topics