Research Activities, November 2010: Outcomes/Effectiveness Research: Colonoscopy is best at diagnosing lower intestinal bleeding

Outcomes/Effectiveness Research
Colonoscopy is best at diagnosing lower intestinal bleeding

When it comes to lower intestinal bleeding (LIB), identifying the source is critical for effective diagnosis and treatment. This can be difficult, particularly at the time a patient presents with the problem. There are a number of currently available radiological procedures available to diagnose and manage LIB. Despite these newer strategies, a recent review of studies on the topic supports the use of colonoscopy as the preferred approach in most patients with LIB.

According to the researchers, colonoscopy provides clear advantages over other radiological procedures. Not only can it provide a diagnosis, but it can also provide an opportunity to stop the bleeding. According to the literature, colonoscopy can diagnose LIB in 75 to 100 percent of patients. Other radiographic tests require active bleeding at the time of the procedure. As such, colonoscopy has a higher diagnostic yield compared with these other tests. In patients with severe bleeding, it is advantageous to perform colonoscopy as soon as possible after a patient presents with LIB, preferably within 12 hours. Urgent colonoscopy can also identify low-risk patients who may be candidates for early discharge. In fact, the time to colonoscopy strongly predicts the length of stay for the patient.

Angiography and other radiologic strategies are best reserved for patients with significant bleeding who cannot be stabilized for a colonoscopy and for patients with obscure bleeding sources. They are not designed for routine cases in that they require active bleeding at the time they are performed. When angiography is used, elderly patients and those with coexisting illnesses may have serious complications. The researchers conclude that colonoscopy remains the preferred strategy for most patients, owing to its high diagnostic yield, low complication rate, and the ability to identify and treat the source of bleeding immediately. The study was supported in part by the Agency for Healthcare Research and Quality (HS14062).

See "The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding," by Lisa L. Strate, M.D., and Christopher R. Naumann, M.D., in Clinical Gastroenterology and Hepatology 8, pp. 333-343, 2010.

Research Activities, November 2010: Outcomes/Effectiveness Research: Colonoscopy is best at diagnosing lower intestinal bleeding