TITLE

Management of Patients with Severe Hematochezia–With All Current Evidence Available

AUTHOR(S)
Jensen, Dennis M.
PUB. DATE
November 2005
SOURCE
American Journal of Gastroenterology;Nov2005, Vol. 100 Issue 11, p2403
SOURCE TYPE
Academic Journal
DOC. TYPE
Editorial
ABSTRACT
A randomized controlled trial (RCT) of routine urgent colonoscopy in severe lower gastrointestinal tract bleeding is reported in this journal from Duke. The only significant differences in results between the standard management (emergency red blood cell (RBC) scanning and angiography with elective colonoscopy) and urgent colonoscopy were in rates of finding a definitive bleeding site—one with a major stigmata of hemorrhage—and in not making a diagnosis. The trial was stopped early for logistics reasons a decade ago. The strengths and limitations of the study are discussed and contrasted with recent reports of other investigators. Similar to management of patients with non-variceal upper gastrointestinal tract (UGI) hemorrhage, triaging patients to level of care by comorbidity scores and stigmata of hemorrhage, successful colonoscopic hemostasis of focal lesions, and individualization of long-term medical, endoscopic, and surgical care are recommended based on promising reports by other investigators. Meanwhile, further RCTs for patients with severe hematochezia are warranted.
ACCESSION #
18613671

 

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