Surgery should be last resort for lower GI bleeding management
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LAS VEGAS – A presenter at the ACG Postgraduate Course discussed evidence-based guidelines which reviewed urgent colonoscopies, radiographic therapeutic approaches and surgery for lower gastrointestinal bleeding.
“Our triage has been simplified and yes indeed GI can sleep,” Lisa L. Strate, MD, MPH, FACG, professor of medicine at the University of Washington School of Medicine in Seattle, said during her postgraduate course presentation prior to ACG 2021.
“For us, our triage has been simplified to two arms — an unstable arm and a stable arm vs. having a third arm in the middle where we weren’t sure if patients had to go to colonoscopy urgently or to radiographic intervention,” Strate continued.
Among the guidelines for lower GI bleeding, Strate highlighted:
- A colonoscopy should be performed next available; however, it is not urgent.
- Physicians should try for high quality preparation.
- Visualization can be improved with an endoscopic cap.
- Mechanical methods such as clips or banding are preferred compared with thermal methods.
- Therapy should be applied directly to or on both sides of the lesion.
- The best test for detection and localization of bleeding is CT angiography.
- After a positive CT angiography, angiography should be performed immediately to ensure good outcomes.
- Surgery is the last resort for GI bleeding.
- If surgery is required, physicians should localize the source before surgery.
“Surgery is the last resort,” Strate said. “Really only in patients who fail everything else that we have available, and we do everything to localize the patient first.”
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Strate LL. Symposium: Lower GI Bleeding - When do you scope vs. sleep? Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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