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Endoscopic management of lower gastrointestinal bleeding

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Opinion statement

Colonoscopy continues to be the primary tool for diagnostic evaluation and management of lower gastrointestinal bleeding (LGIB). With the advent of newer endoscopy delivery therapeutic modalities, the treatment of LGIB has changed dramatically over the decades. The most dramatic change has been the role of surgery, which has been substantially reduced due to the therapeutic colonoscopy. This article reviews recent advances in the endoscopic treatment options in LGIB of the colon and rectum.

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Arya, N., Marcon, N.E. Endoscopic management of lower gastrointestinal bleeding. Curr Treat Options Gastro 7, 241–247 (2004). https://doi.org/10.1007/s11938-004-0045-x

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