Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000;342:78-82.
- Signs of diverticular hemorrhage is found in 23% of patients with lower gastrointestinal bleeding who undergo urgent colonoscopy (6-12 hours after hospitalization)
- Adequate colon preparation was extremely important; patients received large volume purge cleansing until clear, average need was 5-6 liters, colonoscopy performed within 1 hr. after clearance of stool.
- Over 50% of patients with endoscopic signs of recent bleeding re-bled if no endoscopic therapy was applied
- Endoscopic therapy using 1-2cc of epinephrine (1:20,000 dilution) followed by bicap electrocoagulation (10W to 15W, 1 second pulses) resulted in no instance of recurrent bleeding among 10 patients treated.
- Signs of recent diverticular bleeding include: active bleeding, visible vessel, adherent clot
FACTS TO REMEMBER FOR BOARDS
- Lower
GI bleeding accounts for 20% of all GI bleeding episodes
- At
most, 20% of patients with diverticular bleeding will have signs on endoscopy showing
evidence of diverticular hemorrhage.
- Patients
with severe lower gastrointestinal bleeding, specially those consuming NSAID’s should
first undergo upper endoscopy to exclude an UGI source of bleeding.
- Stigmata
of recent bleeding in the lower GI tract are the same ones we recognize in the upper GI
tract.
- Patients
with acute lower GI bleeding should undergo prompt colonic cleasing with a purge solution,
cleansing should continue until the stool is clear, often requiring more than 4 liters
- During
colonoscopy, if stigmata of recent bleeding are identified, endoscopic therapy following
the same guidelines as for UGIB lesions, should be applied.