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Lower Gastrointestinal Bleeding

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ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding.
Strate LL, Gralnek IM.
Am J Gastroenterol. 2016 May;111(5):755.

Rationale for inclusion: This article provides a nice summary of management of lower GI bleeding.

Citations - 37 (as of July 2017)

Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopy.
Nagata N, Niikura R, Aoki T, Moriyasu S, Sakurai T, Shimbo T, Shinozaki M, Sekine K, Okubo H, Watanabe K, Yokoi C, Yanase M, Akiyama J, Uemura N.
J Gastroenterol. 2015 Dec;50(12):1162-72.

Rationale for inclusion: This is a small study but addresses one of the dilemmas with LGIB; to scan or to perform endoscopy. In a small cohort of patients, the authors demonstrate some benefit with contrast-enhanced multidetector computed tomography for acute LGIB in localizing the lesion.

Citations - 15 (as of July 2017)

Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants.
Lanas Á, Carrera-Lasfuentes P, Arguedas Y, García S, Bujanda L, Calvet X, Ponce J, Perez-Aísa Á, Castro M, Muñoz M, Sostres C, García-Rodríguez LA.
Clin Gastroenterol Hepatol. 2015 May;13(5):906-12.e2.

Rationale for inclusion: The common use of NSAIDS and oral anticoagulants necessitate an understanding of the risks associated with their use. This study confirms that GI bleeds are increased when these agents are used.

Citations - 65 (as of July 2017)

Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding.
Laine L, Shah A.
Am J Gastroenterol. 2010 Dec;105(12):2636-41; quiz 2642.

Rationale for inclusion: this study confirmed the importance of performing upper endoscopy in patients with clinically significant lower GI bleeding with hemodynamic instability; 15% had an upper GI source of bleeding.

Citations - 103 (as of July 2017)

Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study.
Kim CY, Suhocki PV, Miller MJ Jr, Khan M, Janus G, Smith TP.
J Vasc Interv Radiol. 2010 Apr;21(4):477-83.

Rationale for inclusion: this study that provoking bleeding by intra-arterial injection of a vasodilator and tissue plasminogen activator successfully uncovered the source of bleeding in about one-third of patients with occult lower GI bleeding.  Complication rates were low and the rates of hemorrhage control (after provocation) were high.

Citations - 34 (as of July 2017)

Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center.
Gayer C, Chino A, Lucas C, Tokioka S, Yamasaki T, Edelman DA, Sugawa C.
Surgery. 2009 Oct;146(4):600-6; discussion 606-7.

Rationale for inclusion: this large retrospective review demonstrates that the most common causes of acute lower GI bleeding are diverticulosis, hemorrhoids, and carcinoma, and that colonoscopy was effective in diagnosis and treatment.

Citations - 96 (as of July 2017)

Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage.
Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, Wilmer A.
Am J Gastroenterol. 2009 Aug;104(8):2042-6.

Rationale for inclusion: this study demonstrates high effectiveness and low complication rates associated with transcatheter angioembolism for lower GI bleeding.

Citations - 37 (as of July 2017)

Emergency subtotal colectomy for lower gastrointestinal haemorrhage: over-utilised or under-estimated?
Plummer JM, Gibson TN, Mitchell DI, Herbert J, Henry T.
Int J Clin Pract. 2009 Jun;63(6):865-8.

Rationale for inclusion: this study reports that sub-total colectomy is the preferred treatment for unrelenting massive lower GI bleeding.  Because most mortalities were secondary to sepsis from anastomotic leak, end ileostomy is recommended.

Citations - 14 (as of July 2017)

The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.
Ell C, Remke S, May A, Helou L, Henrich R, Mayer G.
Endoscopy. 2002 Sep;34(9):685-9.

Rationale for inclusion: this study demonstrates the utility of wireless capsule endoscopy in identifying occult GI bleeding and its superiority over push enteroscopy.

Citations - 845 (as of July 2017)

Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, and tolazoline.
Ryan JM, Key SM, Dumbleton SA, Smith TP.
J Vasc Interv Radiol. 2001 Nov;12(11):1273-7.

Rationale for inclusion: this is another provocative mesenteric angiography study demonstrating a similar one-third success rate.

Citations - 91 (as of July 2017)

Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding.
Farner R, Lichliter W, Kuhn J, Fisher T.
Am J Surg. 1999 Dec;178(6):587-91.

Rationale for inclusion: this study supports the practice of total colectomy for the treatment of ongoing lower GI bleeding.  Compared to limited colonic resection, the rebleeding rate was much lower (4% vs. 18%).

Citations - 57 (as of July 2017)

Bleeding colonic diverticula. A reappraisal of natural history and management.
McGuire HH Jr.
Ann Surg. 1994 Nov;220(5):653-6.

Rationale for inclusion: this study has two main clinical pearls: 1) most (75%) bleeding stops spontaneously, and 2) “blind” colon resection is unsafe.

Citations - 327 (as of July 2017)

Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding.
Hunter JM, Pezim ME.
Am J Surg. 1990 May;159(5):504-6.

Rationale for inclusion: this study demonstrates the limited utility of nuclear imaging (technetium scintigraphy) for localizing the source of lower GI bleeding.  Performing resection based on results of scintigraphy resulted in surgical error 42% of the time!

Citations - 155 (as of July 2017)

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