What is the role of endoscopic hemostasis therapy in the management of 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

In patients who are hemodynamically stable with mild to moderate bleeding or in patients who have had a massive bleed that has stabilized, colonoscopy should be performed initially. [5, 41] Once the bleeding site is localized, therapeutic options include coagulation and injection with vasoconstrictors or sclerosing agents.

In cases of diverticular bleeding, bipolar probe coagulation, epinephrine injection, and metallic clips may be used. [5] If recurrent bleeding is present, the affected bowel segment can be resected. In cases of angiodysplasia, thermal therapy, such as electrocoagulation or argon plasma coagulation, is generally successful. Angiodysplastic lesions may be missed at colonoscopy if the lesions are small or covered with blood clots.

Endoscopic hemostasis therapy is a safe and effective method to control high-risk indications of hemorrhage: active bleeding, nonbleeding visible vessel, or adherent clot. [5, 60] It is also effective for diverticular bleeding, angioectasia bleeding, and postpolypectomy bleeding. [5]

In patients with brisk, active lower gastrointestinal bleeding, obtain surgical consultation. [5]


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