Lower gastrointestinal bleeding diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Colonoscopy is the gold standard test for the diagnosis of lower gastrointestinal bleeding. However, endoscopy is the investigation of choice in cases of lower gastrointestinal bleeding caused by ischemic colitis.
Diagnostic Study of Choice
- Colonoscopy is recommended as the first-line investigation in patients presenting with LGIB.[1][2][3][4][5][6][7]
Advantages
The advantages of colonoscopy as an initial investigation include:
- The ability to accurately locate and visualize the site of the bleeding, and the potential for therapeutic intervention.
Disadvantages
- Disadvantages of colonoscopy include poor visualization in an unprepared colon.
- Risk of fluid overload in the acutely ill patient receiving rapid bowel preparation.
Interpretation
- The sensitivity of colonoscopy in detecting lesions such as angiodysplasia depends on good bowel preparation, and it is estimated to exceed 80%.
- The sensitivity of colonoscopy in detecting bleeding lesions, however, is estimated at 48% to 90%. Therefore, a bleeding site is frequently not identified.
- Despite the disadvantages, complete colonoscopy can be carried out in more than 95% of patients, and a source of bleeding can be identified by colonoscopy in 74% to 82% of patients.
- There is a risk of bowel perforation with colonoscopy, especially in patients with colitis.
Endoscopy
- Endoscopy is the investigation of choice for ischemic colitis; however, it is not recommended to perform endoscopy in a patient with severe abdominal pain or peritonitis.[8][9]
- In cases in which no source of bleeding is seen on colonoscopy, esophagogastroduodenoscopy should be undertaken, as occasionally, brisk UGIB increases transit time and presents as blood per rectum.[10]
- Endoscopic evaluation of the small bowel may include a combination of endoscopic techniques, such as wireless capsule endoscopy and small bowel enteroscopy (double balloon, push or spiral enteroscopy).
- These modalities are often used if colonoscopy and esophagogastroduodenoscopy have failed to identify the source of gastrointestinal blood loss.
- Advantages of capsule endoscopy are that it is technically easier to use, is noninvasive, and does not require sedation. However, it lacks endoscopic access for therapeutic intervention.
- Capsule endoscopy has a higher diagnostic yield in bleeding patients than enteroscopy, 56% and 26% respectively, and is, therefore, often performed before enteroscopy. If a bleeding lesion is visualized, then endoscopic intervention can be considered
CT angiography (CTA)
- CTA may be a more appropriate first-line investigation in patients with abdominal pain or suspected peritonitis.[11]
References
- ↑ Lhewa DY, Strate LL (2012). "Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding". World J. Gastroenterol. 18 (11): 1185–90. doi:10.3748/wjg.v18.i11.1185. PMC 3309907. PMID 22468081.
- ↑ Jang BI (2013). "Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia?". Clin Endosc. 46 (5): 476–9. doi:10.5946/ce.2013.46.5.476. PMC 3797929. PMID 24143306.
- ↑ Kouanda AM, Somsouk M, Sewell JL, Day LW (2017). "Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis". Gastrointest. Endosc. 86 (1): 107–117.e1. doi:10.1016/j.gie.2017.01.035. PMID 28174123.
- ↑ Strate LL (2010). "Editorial: Urgent colonoscopy in lower GI bleeding: not so fast". Am. J. Gastroenterol. 105 (12): 2643–5. doi:10.1038/ajg.2010.401. PMID 21131933.
- ↑ Navaneethan U, Njei B, Venkatesh PG, Sanaka MR (2014). "Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study". Gastrointest. Endosc. 79 (2): 297–306.e12. doi:10.1016/j.gie.2013.08.001. PMID 24060518.
- ↑ Chaudhry V, Hyser MJ, Gracias VH, Gau FC (1998). "Colonoscopy: the initial test for acute lower gastrointestinal bleeding". Am Surg. 64 (8): 723–8. PMID 9697900.
- ↑ Barnert J, Messmann H (2009). "Diagnosis and management of lower gastrointestinal bleeding". Nat Rev Gastroenterol Hepatol. 6 (11): 637–46. doi:10.1038/nrgastro.2009.167. PMID 19881516.
- ↑ Sonnenberg A (2014). "Timing of endoscopy in gastrointestinal bleeding". United European Gastroenterol J. 2 (1): 5–9. doi:10.1177/2050640613518773. PMC 4040802. PMID 24918002.
- ↑ Whitlow CB (2010). "Endoscopic treatment for lower gastrointestinal bleeding". Clin Colon Rectal Surg. 23 (1): 31–6. doi:10.1055/s-0030-1247855. PMC 2850164. PMID 21286288.
- ↑ Wong Kee Song LM, Baron TH (2008). "Endoscopic management of acute lower gastrointestinal bleeding". Am. J. Gastroenterol. 103 (8): 1881–7. doi:10.1111/j.1572-0241.2008.02075.x. PMID 18796089.
- ↑ Clerc D, Grass F, Schäfer M, Denys A, Demartines N, Hübner M (2017). "Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?". World J Emerg Surg. 12: 1. doi:10.1186/s13017-016-0112-3. PMC 5215140. PMID 28070213.