Procedure

Colonoscopy in GI Bleeding

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Colonoscopy in GI Bleeding, Lower Endoscopy Evaluation of GI Bleeding, Lower GI Endoscopic Evaluation of Bleeding

Indications

Acute Lower Gastrointestinal Bleeding

Protocol
Timing (Hospitalized patients)

Colonoscopy within 12-48 hours
1. Allows for adequate Bowel Preparation
2. Allows for adequate Resuscitation

Preparation

Adequate Bowel Preparation is key to diagnosis
Rapid Bowel Preparation in urgent Colonoscopy (colonic lavage with purge preparation)
1. Uses Polyethylene Glycol (PEG 3350, Golytely, Nulytely)
2. Polyethylene Glycol at 1 liter every 30-45 minutes for at least 2 hours until clear effluent OR
3. Polyethylene Glycol 4 to 6 Liters over 3-4 hours until output without stool or blood

Diagnosis
Colonoscopy

Pitfalls
1. Definite bleeding source in suspected Diverticular Bleeding is only identified in 10-20% of cases
  1. However overall identifies 69-80% of Lower Gastrointestinal Bleeding causes
2. High False Positive Rate for wrong site of bleeding
3. Sites commonly misdiagnosed as bleeding source
  1. Diverticular Bleeding
  2. Angiodysplasia
Criteria for definitive diagnosis of bleeding source
1. Active bleeding
2. Nonbleeding visible vessel or pigmented protuberance
3. Clot adherent to bleeding source
4. Fresh blood in a short colonic segment
5. Diverticular ulceration with fresh blood nearby

Signs
Colonoscopy findings on evaluation of Lower Gastrointestinal Bleeding

Management
Modalities for control of bleeding sites

Thermal contact probe
Nd-YAG Laser
Dilute epinephine injection with electrocautery
Band ligation or metallic clip placement

References