Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature

Lower gastrointestinal bleeding is common and occurs often in elderly patients. In rare cases it is associated with hemorrhagic shock. A large number of such bleedings, which are often caused by colon diverticula, subside spontaneously. Alternatively they can be treated by endoscopic procedures successfully. Given the aging population of our society, the rising incidence of lower gastrointestinal tract bleeding and new anticoagulant therapies, some of the bleedings tend to be severe. Colonoscopy is the established standard procedure for the diagnosis and treatment of lower gastrointestinal bleeding. However, a small number of patients experience re-bleeding or shock; their bleeding does not resolve spontaneously and cannot be treated successfully by endoscopic procedures. In such patients, interventional radiology is very useful for the detection of bleeding and the achievement of hemostasis. Against this background we performed a literature search using PubMed to identify all relevant studies focused on the endoscopic and radiological management of lower gastrointestinal bleeding and present recent conclusions on the subject.

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A prospective multicenter observational study evaluating the risk of periendoscopic events in patients using anticoagulants: the Osaka GIANT Study

Endoscopy International Open ◽

10.1055/a-0754-1997 ◽

2019 ◽

Vol 07 (02) ◽

pp. E104-E114 ◽

Cited By ~ 2

Author(s):

Takuya Inoue ◽

Hideki Iijima ◽

Takuya Yamada ◽

Yuji Okuyama ◽

Kanae Takahashi ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Endoscopic Biopsy ◽

Thromboembolic Events ◽

Endoscopic Procedures ◽

Multicenter Observational Study ◽

Number Of Patients ◽

Duration Of Hospitalization

Abstract Background and study aims An increasing number of patients have been using anticoagulants including anti-vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs); however, in patients using anticoagulants, limited data are available with regard to the risks of gastrointestinal bleeding and thromboembolic events during the peri-endoscopic period. We aimed to evaluate the peri-endoscopic bleeding and thrombotic risks in patients administered VKAs or DOACs. Patients and methods Consecutive patients using anticoagulants who underwent endoscopic biopsy, mucosal resection, or submucosal dissection were prospectively enrolled across 11 hospitals. The primary outcome assessed was difference in incidence of post-procedural gastrointestinal bleeding in patients using VKAs and DOACs. Duration of hospitalization and peri-procedural thromboembolic events were also compared. Results We enrolled 174 patients using VKAs and 37 using DOACs. In total, 16 patients using VKA were excluded from the analysis because of cancellation of endoscopic procedures and contraindications to the use of DOACs; 128 (81 %) patients using VKAs and 17 (46 %) using DOACs received heparin-bridging therapy (HB). The rate of post-procedural gastrointestinal bleeding in DOAC users was similar to that in VKA users (16.2 % vs. 16.4 %, P = 1.000). Duration of hospitalization was significantly longer in patients using VKAs than in those using DOACs (median 15 vs. 7 days, P < 0.0001). Myocardial infarction occurred during pre-endoscopic HB in one patient using VKAs. Conclusion DOAC administration showed similar post-procedural gastrointestinal bleeding risk to VKA administration in patients undergoing endoscopic procedures, but it shortened the hospital stay.

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A practical alternative for salvage therapy in Gastrointestinal Bleeding: Ankaferd Blood Stopper

Journal of Experimental and Clinical Medicine ◽

10.52142/omujecm.38.si.gastro.9 ◽

2021 ◽

Vol 38 (SI-1) ◽

pp. 61-64

Author(s):

Berk BAŞ ◽

Talat AYYILDIZ ◽

Ufuk AVCIOĞLU

Keyword(s):

Gastrointestinal Bleeding ◽

Salvage Therapy ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Medical Problem ◽

Lower Gastrointestinal Bleeding ◽

Endoscopic Procedures ◽

Plasma Coagulation ◽

Heater Probe ◽

Ankaferd Blood Stopper

Upper and lower gastrointestinal bleeding is a medical problem that is encountered in the clinic quite often. Endoscopic procedures still constitute the basis of the treatment in gastrointestinal bleeding. Hemoclips, argon plasma coagulation, sclerotherapy, heater probe, and hemosprays accompanied by endoscopy are used alone or in combination. In this study, we shared our experience of using the drug called Ankaferd blood stopper, which is indicated for use in many forms of bleeding, in 64 patients who applied to our clinic with upper or lower gastrointestinal bleeding between January 2019 and April 2020.

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Acute lower gastrointestinal bleeding

Medicinski pregled ◽

10.2298/mpns1412361j ◽

2014 ◽

Vol 67 (11-12) ◽

pp. 361-366 ◽

Cited By ~ 4

Author(s):

Tatiana Jocic ◽

Olgica Latinovic-Bosnjak ◽

Ljiljana Hadnadjev ◽

Dragomir Damjanov ◽

Zeljka Savic ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Malignant Tumors ◽

Medical Condition ◽

Total Mortality ◽

Diagnostic Procedures ◽

Lower Gastrointestinal Bleeding ◽

Therapeutic Modalities ◽

Number Of Patients ◽

Colon Diverticulosis ◽

Anorectal Diseases

Introduction. Acute lower gastrointestinal bleeding accounts for approximately 20% of all acute gastrointestinal hemorrhages, and they are the most common urgent cases in gastroenterology. The aim of this study was to determine the most common etiology, efficacy in diagnostics and therapy, and the outcome in patients with acute lower gastrointestinal bleeding. Material and Methods. Data were collected from the medical records of 86 patients who had been hospitalized for acute lower gastrointestinal bleeding in 2009 at the Ward of Gastroenterology and Hepatology, Clinical Centre of Vojvodina. Results. The average age of the patients was 70.4 years (ranging from 37 to 88), and the largest number of patients 41/86 (47.7%) were between the ages 71 and 80. Colon diverticulosis was the most common cause of bleeding, and it occurred in 21 patients from the study sample (24.4%), and the other causes were malignant tumors (12/86, i.e. 13.9%), polyps (10/86, i.e. 11.6%), anorectal diseases (7/86, i.e. 8.3%) and colitis (8/86, i.e. 9.3%). No diagnostic procedures were performed in 15 patients (17.4%) due to their poor medical condition and comorbidities. The total mortality rate was 6/86 (6.9%), and the largest number of deaths occurred (5/86 i.e. 5.8%) due to a multisystem organ failure and underlying diseases which were not associated with acute lower gastrointestinal bleeding. Uncontrolled bleeding was the cause of death in only 1 patient (1.2%). Conclusions. Acute lower gastrointestinal bleeding is most commonly found in the older population, whose age, comorbidities, and ongoing therapy have impact on bleeding lesions, diagnostic and therapeutic modalities and the outcomes of bleeding. Endoscopic procedures are still the gold standard in diagnostics.

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