Lower Gastrointestinal Bleeding - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

Lower Gastrointestinal Bleeding

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Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding

Niikura R, Nagata N, Yamada A, Honda T, Hasatani K, Ishii N, Shiratori Y, Doyama H, Nishida T, Sumiyoshi T, Fujita T, Kiyotoki S, Yada T, Yamamoto K, Shinozaki T, Takata M, Mikami T, Mabe K, Hara K, Fujishiro M, Koike K.

Gastroenterology. 2020 Jan;158(1):168-175.e6.

Rationale for Inclusion: Large, multicenter, randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower gastrointestinal bleeding compared to colonoscopy done 24-96 hours after hospital admission

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Early versus standard colonoscopy a randomized controlled trial in patients with acute lower gastrointestinal bleeding: results of the BLEED study

van Rongen I, Thomassen BJW, Perk LE.

J Clin Gastroenterol. 2019 Sep;53(8):591-598.

Rationale for Inclusion: Randomized controlled trial evaluating the efficacy of <24 hrs vs 1-3 days colonoscopy to evaluate for lower GI bleeding

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Rebleeding and mortality after lower gastrointestinal bleeding in patients taking antiplatelets or anticoagulants

Oakland K, Desborough MJ, Murphy MF, Schachter M, Jairath V.

Clin Gastroenterol Hepatol. 2019 Jun;17(7):1276-1284.

Rationale for Inclusion: Large, retrospective review delineating the effects of various antiplatelet and anticoagulant medications on lower GI rebleeding.

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Transcatheter Arterial Embolization in Lower Gastrointestinal Bleeding: Ischemia Remains a Concern Even with a Superselective Approach.

Nykänen T, Peltola E, Kylänpää L, Udd M.

J Gastrointest Surg. 2018 Aug;22(8):1394-1403.

Rationale for inclusion: This single Finnish center study demonstrated the elevated success rate of TAE (96%) with 17% post TAE ischemia rate requiring resection, supporting the TAE as second option of treatment of GIB after colonoscopy and before surgery.

CAVEAT: Finnish study.

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Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study.

Oakland K, Jairath V, Uberoi R, Guy R, Ayaru L, Mortensen N, Murphy MF, Collins GS.

Lancet Gastroenterol Hepatol. 2017 Sep;2(9):635-643.

Rationale for Inclusion: Large prospective study used to develop and validate a novel clinical prediction model with good discriminative performance in identifying patients with lower gastrointestinal bleeding who are candidates for safe outpatient management, yielding important resource and economic implications..

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Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: a meta-analysis.

He B, Yang J, Xiao J, Gu J, Chen F, Wang L, Zhao C, Qian J, Gong S.

Eur J Radiol. 2017 Aug;93:40-45.

Rationale for Inclusion: A total of 14 articles with 549 patients were included in the meta-analysis. The study showed multi-slice spiral CTA has high value (sensitivity 90% and specificity 92%) in the diagnosis of lower gastrointestinal bleeding and should be considered an adjunct in the clinical treatment of lower GI bleeds.

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Neural network prediction of severe lower intestinal bleeding and the need for surgical intervention.

Loftus TJ, Brakenridge SC, Croft CA, Smith RS, Efron PA, Moore FA, Mohr AM, Jordan JR.

J Surg Res. 2017 May 15;212:42-47.

Rationale for Inclusion: Artificial neural network (ANN) models have outperformed scoring systems based on regression models in predicting severe bleeding. This study compared ANNs to the Strate model in predicting acute lower intestinal bleed (ALIB). The Strate model was less accurate than an ANN featuring six variables present on admission: hemoglobin, systolic blood pressure, outpatient prescription for Aspirin 325 mg daily, Charlson comorbidity index, base deficit, and international normalized ratio. A similar ANN predicted the need for surgery by integrating two additional parameters: hemoglobin nadir and the occurrence of a 20% decrease in hematocrit. The optimal approach to clinical prognostication may incorporate the efficiency and pragmatism regression-based risk calculators and the accuracy of ANNs.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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%).

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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!

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