Endoscopic Therapy

Endoscopic therapy is increasingly used for lower GI bleeding, although less commonly than for upper GI bleeding (27% compared to 51%, respectively), based on a recent ACG survey. In patients with diverticular bleeding, therapeutic options for high risk lesions (active bleeding, visible vessel) that can be delivered through the colonoscope include thermal contact modalities, such as heater probe or bipolar/multipolar coagulation, or epinephrine injection, which may be used independently or in conjunction. The use of metallic clips for treating diverticular hemorrhage has also been reported. An initial study looking at the impact of endoscopic intervention on diverticular bleeding found that none of the patients treated endoscopically had persistent or recurrent bleeding, or required surgery, compared with 35% in the group treated conservatively (Jensen et al, 2000). A recent randomized, controlled trial performed at our institution revealed that urgent colonoscopy identified a definite bleeding source in 42% of cases of lower GI bleeding compared to 8% with tagged RBC scan followed by angiography. The rates of rebleeding for patients who underwent urgent colonoscopy versus those who underwent radiologic intervention were 16% and 14%, respectively, after a mean follow-up of approximately 5 years. However, this difference did not reach statistical significance. There was no difference in mortality, hospital stay, or need for surgery between both groups (Green et al, 2003).

Bleeding caused by angiodysplasia can be treated with thermal modalities, injection or noncontact modalities, such as argon plasma coagulation (APC). These lesions are usually found in the cecum and right colon. The use of low power settings with thermal modalities is recommended (10 to 15 J with heater probe; 10 to 15 W, 1 s pulses with bipolar probe) to reduce the risk of perforation. To reduce risk of bleeding during cautery, large lesions should be initially treated around the circumference to obliterate feeder vessels before the center of the lesion is treated. Endoscopic cautery techniques are effective in controlling radiation-induced rectal bleeding. Thermal contact modalities are effective in decreasing bleeding episodes. Lasers, including Nd:YAG and argon, have been used successfully for treating telangiectasias in radiation proctitis. Usually, one to three sessions are required. APC is also used and has several advantages over laser, including a more superficial burn, portability, and lower risk of transmural necrosis, stricture formation, and perforation.

Postpolypectomy bleeding can occur immediately or weeks after the procedure. Early rebleeding can be treated by compressing the remaining polyp stalk with a metal snare, detachable plastic snares, or metallic clips. Delayed bleeding can be managed conservatively in the majority of patients. Endoscopic therapy is a safe and effective option in patients with persistent bleeding. Angiotherapy or surgery is usually not required.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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