Topic Highlight
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2012; 18(11): 1185-1190
Published online Mar 21, 2012. doi: 10.3748/wjg.v18.i11.1185
Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding
Dekey Y Lhewa, Lisa L Strate
Dekey Y Lhewa, Division of Hospital and Specialty Medicine, Department of Medicine, Puget Sound Health Care System - Seattle Division, Seattle, WA 98108, United States
Lisa L Strate, Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA 98104, United States
Author contributions: Lhewa DY and Strate LS equally contributed to the writing of this paper.
Correspondence to: Lisa L Strate, MD, MPH, Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine and Harborview Medical Center, 325 Ninth Avenue, 359773 Seattle, WA 98104, United States.
Telephone: +1-206-7447058 Fax: +1-206-7448698
Received: June 2, 2011
Revised: August 25, 2011
Accepted: August 31, 2011
Published online: March 21, 2012

Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy, colonoscopy, angiography, radionuclide scintigraphy and multi-detector row computed tomography. Although no modality has emerged as the gold standard in the management of LGIB, colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source. Colonoscopy has the ability to diagnose all sources of bleeding from the colon and, unlike the radiologic modalities, does not require active bleeding at the time of the examination. In addition, therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding. Studies suggest that colonoscopy, particularly when performed early in the hospitalization, can decrease hospital length of stay, rebleeding and the need for surgery. However, results from available small trials are conflicting and larger, multicenter studies are needed. Compared to other management options, colonoscopy is a safe procedure with complications reported in less than 2% of patients, including those undergoing urgent examinations. The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol), the logistical complexity of coordinating after-hours colonoscopy, and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB, particularly in urgent situations. This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

Keywords: Colonoscopy, Acute lower gastrointestinal bleeding, Management, Diagnostic yield, Therapeutic intervention, Outcomes, Colon preparation, Stigmata of hemorrhage