Usefulness of early colonoscopy in the diagnosis and treatment of moderate or severe lower gastrointestinal bleeding

Journal of Coloproctology - Tập 37 - Trang 25-30 - 2017
Paulo Correa1, Carolina Teixeira1, Rodrigo R. Zago1, Giulio Rossini1, Jose Luiz Paccos1, Pedro Popoutchi1, Jarbas F. Loureiro1, Jose Luiz Borges1, Marcelo Averbach1
1Hospital Sírio Libanês, São Paulo, SP, Brazil

Tóm tắt

Abstract

A total of 38,686 colonoscopies were performed between January 1985 and December 2012 at Hospital Sírio-Libanês, in São Paulo, Brazil. Two hundred thirty-four patients (0.6%) had acute lower gastrointestinal bleeding of moderate or severe intensity. A definitive diagnosis was possible in 151 cases, 64.5% of these patients.

This study was approved by the Institutional Review Board. Medical charts were reviewed.

All examinations were done under sedation by the same medical team.

The predominant sources of bleeding were colonic diverticula (73 patients; 31%), ischemic or infectious colitis (18 patients; 7.7%) and radiation proctitis (18 patients; 7.7%).

A specific therapeutic intervention was performed on 61 of the 151 patients who had the diagnosis confirmed (40.4%), according to the source of bleeding. Most patients with postpolypectomy bleeding were treated with injection of epinephrine (40%) and clipping (40%). Patients with angiodysplasia were treated predominantly with argon plasma coagulation (42%).

Injection of epinephrine was the most frequent treatment, regardless of the source of bleeding (34.4%), followed by argon plasma coagulation (31.1%).

Control of active hemorrhage was achieved endoscopically in 98.8% of the patients.

Our data shows that early colonoscopy in the management of patients with suspected acute lower gastrointestinal bleeding is a useful tool for diagnosis and treatment.


Tài liệu tham khảo

Barnert, 2009, Diagnosis and management of lower gastrointestinal bleeding, Nat Rev Gastroenterol Hepatol, 6, 637, 10.1038/nrgastro.2009.167 Bounds, 2007, Lower gastrointestinal bleeding, Gastrointest Endosc Clin N Am, 17, 273, 10.1016/j.giec.2007.03.010 Peura, 1997, The American College of Gastroenterology Bleeding Registry: preliminary findings, Am J Gastroenterol, 92, 924 Strate, 2003, Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding, Am J Gastroenterol, 98, 317 Velayos, 2004, Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study, Clin Gastroenterol Hepatol, 2, 485, 10.1016/S1542-3565(04)00167-3 Davila, 2005, ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding, Gastrointest Endosc, 62, 656, 10.1016/j.gie.2005.07.032 Longstreth, 1997, Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study, Am J Gastroenterol, 92, 419 Edelman, 2007, Lower gastrointestinal bleeding: a review, Surg Endosc, 21, 514, 10.1007/s00464-006-9191-7 Elta, 2004, Urgent colonoscopy for acute lower-GI bleeding, Gastrointest Endosc, 59, 402, 10.1016/S0016-5107(03)02721-4 Caos, 1986, Colonoscopy after Golytely preparation in acute rectal bleeding, J Clin Gastroenterol, 8, 46, 10.1097/00004836-198602000-00010 Chaudhry, 1998, Colonoscopy: the initial test for acute lower gastrointestinal bleeding, Am Surg, 64, 723 Zuckerman, 1999, Acute lower intestinal bleeding. Part II. Etiology, therapy, and outcomes, Gastrointest Endosc, 49, 228, 10.1016/S0016-5107(99)70491-8 Strate, 2005, Lower GI bleeding: epidemiology and diagnosis, Gastroenterol Clin N Am, 34, 643, 10.1016/j.gtc.2005.08.007 Bounds, 2003, Lower gastrointestinal bleeding, Gastroenterol Clin N Am, 32, 1107, 10.1016/S0889-8553(03)00086-4 Savides, 1994, Colonoscopic hemostasis for recurrent diverticular hemorrhage associated with a visible vessel: a report of three cases, Gastrointest Endosc, 40, 70, 10.1016/S0016-5107(94)70014-1 Jensen, 2000, Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage, N Engl J Med, 342, 78, 10.1056/NEJM200001133420202 Pilichos, 2008, Role of endoscopy in the management of acute diverticular bleeding, World J Gastroenterol, 14, 1981, 10.3748/wjg.14.1981 Green, 2005, Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial, Am J Gastroenterol, 100, 2395, 10.1111/j.1572-0241.2005.00306.x Laine, 2010, Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding, Am J Gastroenterol, 105, 2636, 10.1038/ajg.2010.277 Boley, 1979, Lower intestinal bleeding in the elderly, Am J Surg, 137, 57, 10.1016/0002-9610(79)90011-4 Kim, 2006, Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study, Am J Gastroenterol, 101, 1333, 10.1111/j.1572-0241.2006.00638.x Consolo, 2008, Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center, World J Gastroenterol, 14, 2364, 10.3748/wjg.14.2364 Bloomfeld, 2001, Endoscopic therapy of acute diverticular hemorrhage, Am J Gastroenterol, 96, 2367, 10.1111/j.1572-0241.2001.04048.x Ohyama, 2000, Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding, Digestion, 61, 189, 10.1159/000007756 Schmulewitz, 2003, Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single center, Gastrointest Endosc, 58, 841, 10.1016/S0016-5107(03)02304-6 El-Tawil, 2012, Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding, World J Gastroenterol, 18, 1185, 10.3748/wjg.v18.i11.1185
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Thông tin xuất bản

Journal of Coloproctology

Tập 37

25-30

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