When is emergent colonoscopy indicated in lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Large amounts of blood in the GI tract act as a cathartic and provide adequate cleanup from stool and other debris. Emergent unprepared hydroflush colonoscopy can be performed in patients with massive LGIB. Initially, these patients are given 1 L of tap water enema three or four times over 1 hour prior to emergent colonoscopy. This technique utilizes a hydro-jet endoscopic irrigation system with a high-powered mechanical suction system. The irrigation pump rate is set to maximum flow rate at the time of the colonoscopy. [42]

Actively bleeding lesions can be treated with colonoscopic thermoregulation, epinephrine injection, photocoagulation, clip application, and a combination of these methods. [17] Incidentally discovered lesions should be left alone.


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