Endoscopic Treatment of Lower Gastrointestinal Bleeding
Lower gastrointestinal bleeding (LGIB) is defined as blood loss in the colon or anorectum. Acute LGIB usually refers to current and/or recent bleeding within 3 days, and chronic LGIB represents blood loss for longer time. Major causes of LGIB are diverticular bleeding, angiodysplasia, hemorrhoid, and colitis of various etiologies including ischemic colitis. The prevalence of LGIB appears to be increasing because of increase in elderly people, coexisting medical illnesses, and frequent use of offending medications. Most acute LGIB stops spontaneously without specific therapy. However, excessive or prolonged LGIB should be treated with endoscopic, angiographic, and/or surgical methods. Urgent colonoscopy remains the mainstay of diagnosis and therapy for acute LGIB. Endoscopic hemostasis methods for acute LGIB include mechanical devices, thermal coagulation, and injection therapy. Endoclip is one of the most commonly used methods, which is easy to use and safe. Although thermal coagulation is effective in various conditions of LGIB, excessive coagulation should be avoided because deeper coagulation in the right colon can cause perforation. The choice of endoscopic hemostatic method for LGIB can be determined by the location and cause of LGIB and endoscopist’s experience. This chapter will describe a variety of endoscopic hemostatic methods for LGIB.
KeywordsLower gastrointestinal bleeding Diverticula Angiodysplasia Colitis Colonoscopy Endoclip Thermocoagulation Hemostasis