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Background: Early colonoscopy (within 8–24 h) is recommended in different guidelines for acute lower gastrointestinal bleeding (LGIB). Despite this recommendation, evidence for its effectiveness are conflicting, and early colonoscopy is often not performed. Objectives: We aimed to evaluate the utility of early colonoscopy by examining the findings during the procedure, and by comparing in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy. Design: This is a retrospective cohort study based on the electronic medical records of a large tertiary hospital in Israel. Methods: All patients hospitalized with acute LGIB to acute wards between 2012 and 2022 were included. First, structured and free-text procedure notes from patients who did undergo early colonoscopy were examined. Second, we compared in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy while adjusting for possible confounders using multivariable regression of the type appropriate for each outcome. Results: Overall, 953 patients were included, of which 90 underwent early colonoscopy. The majority (54%) were found insufficiently prepared. Common findings were diverticulosis (38%) and colon polyps (20%). The procedure was effective for hemostasis in only 13% of the cases. Early colonoscopy was not significantly associated with increased survival (exponentiated coefficient = 1.19, 95% CI: 0.76, 1.87), decreased length of hospitalization (exponentiated coefficient = 1.08, 95% CI: 0.97, 1.21), or increased blood hemoglobin at discharge (coefficient =−0.27, 95% CI: −0.58, 0.03). Conclusions: Early colonoscopy was often not effective and was not associated with significantly improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Early colonoscopy (within 8–24 h) is recommended in different guidelines for acute lower gastrointestinal bleeding (LGIB). Despite this recommendation, evidence for its effectiveness are conflicting, and early colonoscopy is often not performed. Objectives: We aimed to evaluate the utility of early colonoscopy by examining the findings during the procedure, and by comparing in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy. Design: This is a retrospective cohort study based on the electronic medical records of a large tertiary hospital in Israel. Methods: All patients hospitalized with acute LGIB to acute wards between 2012 and 2022 were included. First, structured and free-text procedure notes from patients who did undergo early colonoscopy were examined. Second, we compared in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy while adjusting for possible confounders using multivariable regression of the type appropriate for each outcome. Results: Overall, 953 patients were included, of which 90 underwent early colonoscopy. The majority (54%) were found insufficiently prepared. Common findings were diverticulosis (38%) and colon polyps (20%). The procedure was effective for hemostasis in only 13% of the cases. Early colonoscopy was not significantly associated with increased survival (exponentiated coefficient = 1.19, 95% CI: 0.76, 1.87), decreased length of hospitalization (exponentiated coefficient = 1.08, 95% CI: 0.97, 1.21), or increased blood hemoglobin at discharge (coefficient = -0.27, 95% CI: -0.58, 0.03). Conclusions: Early colonoscopy was often not effective and was not associated with significantly improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute gastrointestinal (GI) bleeding is one of the leading causes of emergency department visits and hospital admissions. CT angiography (CTA) has had an expanding role in the evaluation of acute GI bleeding because it is rapidly performed, widely available, reasonably sensitive and provides precise localization when positive. We attempted to identify patient and clinical characteristics that predict CTA results in order to help guide the utilization of this modality in patients with acute GI bleeding. Methods: In this retrospective study, we analyzed all CTAs performed for the evaluation of GI bleeding in the Duke University healthcare system between October 2019 and March 2020. We captured patient characteristics including age, sex, vital signs, hemoglobin, platelets, PT/INR, and anticoagulation status. Study indications were grouped by suspected source of bleeding: upper GI bleeding (hematemesis or coffee-ground emesis) vs small bowel bleeding (melena or "dark stools") vs lower GI bleeding (hematochezia or bright red blood per rectum (BRBPR)). Chi-square, Wilcoxon, t test, and multivariate logistic regression were used to describe and assess the relationship between patient characteristics and study outcomes (Table 1). Table 1 Univariate analysis of patient characteristics by CT angiography outcome Patient Characteristics by Positive CT for GI Bleed No (N = 274) Yes (N = 43) Total (N = 317) p value Gender 0.451 Female 138 (50.4%) 19 (44.2%) 157 (49.5%) Male 136 (49.6%) 24 (55.8%) 160 (50.5%) Age, median (Q1,Q3) 65 (51,75) 70 (62,80) 66 (52, 76) < 0.012 Heart rate, median (Q1,Q3) 86 (74,100) 89 (72,98) 86 (74, 99) 0.782 MAP, mean (SD) 87.32 (15.52) 81.72 (16.53) 86.56 0.033 Shock index, median (Q1,Q3) 0.70 (0.58, 0.85) 0.78 (0.55, 1.00) 0.71 (0.58, 0.85) 0.352 Hemoglobin 0.332 N 273 43 316 Median (Q1, Q3) 8.50 (6.90, 11.00) 7.70 (6.50, 11.30) 8.45 (6.90, 11.00) Baseline hemoglobin 0.202 N 258 39 297 Median (Q1, Q3) 11.20 (9.40, 13.00) 12.00 (9.40, 14.00) 11.20 (9.40, 13.00) Hemoglobin drop from baseline 0.062 N 258 39 297 Median (Q1, Q3) 2.10 (0.60, 3.70) 2.70 (1.20, 4.80) 2.20 (0.70, 3.80) Platelets, median (Q1, Q3) 219.5 (141, 301) 183 (139, 246) 217 (139, 282) 0.102 INR 0.272 N 263 42 305 Median (Q1, Q3) 1.10 (1.00, 1.30) 1.20 (1.00, 1.30) 1.10 (1.00, 1.30) Anticoagulation 0.131 No 155 (56.6%) 19 (44.2%) 174 (54.9%) Yes 119 (43.4%) 24 (55.8%) 143 (45.1%) Upper GI bleeding 0.401 No 251 (91.6%) 41 (95.3%) 292 (92.1%) Yes 23 (8.4%) 2 (4.7%) 25 (7.9%) Small Bowel bleeding 0.761 No 216 (78.8%) 33 (76.7%) 249 (78.5%) Yes 58 (21.2%) 10 (23.3%) 68 (21.5%) Lower GI bleeding 0.091 No 134 (48.9%) 15 (34.9%) 149 (47.0%) Yes 140 (51.1%) 28 (65.1%) 168 (53.0%) 1Chi-Square 2Wilcoxon 3Equal Variance T-Test Results: A total of 317 patients underwent CTA between October 2019 and March 2020. Forty-three patients (13.6%) had a CTA positive for active bleeding. Multivariable logistic regression showed that after controlling for age, mean arterial pressure (MAP) and indication, only a hemoglobin drop from baseline was significantly associated with a positive CTA. For each 1 g / dL drop in hemoglobin from the patient's baseline, the odds of a positive CT increased by 1.17 (OR 1.17 95% CI 1.00 – 1.36, p = 0.04). Age (OR 1.02 95% CI 0.99 – 1.04, p = 0.06) and hematochezia / BRBPR (OR 2.09 95% CI 0.94—4.64, p = 0.07) approached statistical significance. Conclusions: In patients who present to the hospital with GI bleeding, CTA can be a helpful triage tool that is most helpful in older patients with suspected lower GI bleeding with a drop in hemoglobin from baseline. Other clinical factors including MAP and the use of anticoagulants were not predictive of a positive CTA. [ABSTRACT FROM AUTHOR]

Background: Angioembolization is a useful therapeutic tool for lower gastrointestinal bleeding (LGIB) however is only available at centres with specialist interventional radiology departments. Delay in angioembolization of greater than 120–150 minutes is associated with higher rates of non‐therapeutic angioembolization. Methods: This retrospective review analysed the impact of interhospital transfer on timing and success of angioembolization in adults with LGIB. Results: Of the 121 patients who underwent CTMA at a peripheral hospital for LGIB, only 20.7% had positive CTMA (n = 25). Of the 24 patients who were transferred for the purpose of angioembolization, only five ultimately had successful embolisation (20.1%). Patients who had unsuccessful angioembolization had a significantly longer mean time from arrival at the tertiary hospital to angioembolization compared to patients who had successful angioembolization (mean 375 versus 175 min, P = 0.001). There was no association of patient haemodynamics, use of anticoagulant or antiplatelet therapy, and transfusion requirement with success of angioembolization. Conclusion: Interhospital transfer is associated with delay in angioembolization. Delay after arrival at the receiving hospital is associated with unsuccessful angioembolization. [ABSTRACT FROM AUTHOR]

Introduction: Lower gastrointestinal bleeding (LGIB) is one of the most common indications for hospital admission. The current standard of care for patients admitted with LGIB includes colonoscopy. The aims of this study are to define the rate of readmission in patients with LGIB and to determine whether early colonoscopy within the first 24 h after admission impacts the rate of readmission in these patients. Methods: We performed a retrospective cohort study on data obtained from the Nationwide Readmission Database and identified patients admitted with lower GI bleed using ICD-10 codes. The primary outcome was 30-day all-cause readmission, and one of our secondary outcomes was the impact of early colonoscopy on 30-day readmission. Results: We analyzed data from 35,790,513 patients who were admitted for LGIB in 2017. A total of 16.4% of these patients were readmitted within 30 days of discharge, with diverticular bleeding most common diagnosis for readmission. Overall, in-hospital mortality was 1.18% for index admission and 4.44% for readmission. Early colonoscopy did not impact the rate of readmission within 30 days of discharge. Conclusion: LGIB remains a commonly encountered in clinical practice with a high readmission rate. Mortality is significantly higher during readmission compared to index admission. Early colonoscopy did not impact the 30-day readmission rate. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of the common causes of lower gastrointestinal bleeding by Colonoscopy as a diagnostic modality in patients with gastrointestinal bleeding. Study Design: Cross Sectional Descriptive study. Setting: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: March 2021 to August 2021. Material & Methods: This study was performed in Liaquat University of Medical and Health Sciences, Jamshoro in patients presenting with lower gastrointestinal bleeding. History, examination and investigations were carried out. After stabilizing the patient lower gastrointestinal endoscopy was performed. Results: Total 139 patients were included in this study. Intermittent bleeding per rectum was the main presenting complaint followed by continuous bleeding per rectum. The average age of the patients was 45.61 ±16.40 years. Out of 139 patients, 94(67.6%) males and 45(32.4%) females. Bleeding related to internal hemorrhoids was present in 40(28.8 %) patients 30(21.6%) male and 10(7.2%) females as the most common cause of lower GI bleed followed by rectal ulcers 14(10.1%) and polyps in 9(6.5%) patients. infective colitis, proctitis and colonic ulcers were noted in 8(5.8%), 6(4.3%) and 5(3.6%) patients respectively. Malignant lesions in colon and rectum were noted in 8(5.8%) and 3(2.2%) patients while ulcerative colitis, crhon's and diverticular disease were noted in 5(3.6%), 1(1.4%), 2(0.7%) patients respectively. 29(%) had normal clonoscopic examination. Conclusion: In our population hemorrhoid bleed is the leading cause of lower gastrointestinal bleeding followed by bleeding due to rectal ulcer and polyps. [ABSTRACT FROM AUTHOR]

Background: Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT. Methods: A 2‐year tertiary institution database was retrospectively reviewed. Outcome measures included 30‐day mortality, 30‐day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office‐hours versus after office‐hours) were analysed using a propensity‐score‐adjusted estimate. Results: A total of 1384 patients were included for analysis, medical (n = 853), surgical (n = 530); during office‐hours (n = 785) and after office‐hours (n = 595). After propensity‐score‐adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P = 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P = 0.04). Patients admitted after office‐hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P = 0.02). Conclusion: For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office‐hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality. [ABSTRACT FROM AUTHOR]

INTRODUCTION The lower gastrointestinal bleeding (LGIB) is an alarming symptom and common disease with annual admission of 0.15% with mortality rate of 5-10%. LGIB is caused by neoplastic and non-neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is gold standard, convenient and cost effective procedure. It is the investigation of choice in LGIB and helps in early diagnosis of colorectal carcinoma. This study was aimed to scrutinize the clinical and colonoscopic findings in patients with LGIB in Universal College of Medical Sciences-Teaching Hospital (UCMS-TH). MATERIAL AND METHODS This was a hospital based prospective observational study conducted after taking permission from institutional review committee in January 2017 at UCMS-TH from 15 January 2017 to 15 January 2018. All patients presenting with LGIB who fulfilled inclusion and exclusion criteria and gave written consent were included. RESULTS Total 88 patients were included in the study. The mean age of our patients was 48 ±17 years with age range from 17-81 years. Majority were in the age group 50-60 years (25%) (n=22). Colonoscopy detected abnormality in 73.8% cases. The common non-neoplastic were haemorrhoids and non-specific colitis (14.5% each) followed by 12.5% of neoplastic cases. The higher frequency of colorectal lesions was observed in males comprising 72.7% (n=64) patients. The most commonly diagnosed etiologies of LGIB were haemorrhoid and nonspecific colitis respectively. CONCLUSION Colonoscopy detected abnormality in 75% of cases. The common causes of LGIB were haemorrhoids and non-specific colitis followed by neoplastic lesion. A careful history, physical and colonoscopic examination with or without biopsy makes significant impact for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Meckel's diverticulum is a congenital anomaly of gastrointestinal tract with an incidence of 2% in the general population. It occurs due to the persistence of omphalomesenteric duct during embryonic period of life. It may be asymptomatic or can manifest as intestinal obstruction or massive lower GI bleeding. It usually presents before the age of 2 years and may contain ectopic tissue. Here, we are reporting a case of 7-year-old child with Meckel's diverticulum presenting as painless bleeding per rectum and anemia. [ABSTRACT FROM AUTHOR]

Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever. [ABSTRACT FROM AUTHOR]

Purpose: Lower gastrointestinal bleeding (LGIB) is any form of bleeding distal to the Ligament of Treitz. In most cases, acute LGIB is self-limited and resolves spontaneously with conservative management. Methods: Only a minority of approximately 10% is admitted to hospital with signs of massive bleeding and shock requiring resuscitation, urgent evaluation and treatment. Results: Over the past decade, there has been a progressive decrease in upper GI events and a significant increase in lower GI events. Overall, mortality has also decreased, but in-hospital fatality due to upper or lower GI complications have remained constant. The problem is that LGIB can arise from a number of sources and may be a significant cause of hospitalisation and mortality in elderly patients. Conclusions: After initial resuscitation, the diagnosis and treatment of LGIB remains a challenge for acute care surgeons, whereby the identification of the source of bleeding is of utmost importance. [ABSTRACT FROM AUTHOR]

Hypochromic, microcytic anaemia due to iron deficiency is usually caused by blood loss due to gynaecologic or gastrointestinal diseases. If no source of bleeding can be found using routine endoscopy and gynaecologic evaluation, a more detailed diagnostic workup must be performed before iron supplementation “ex juvantibus” is initiated. Here, we present a patient with progressive iron deficiency anaemia despite iron supplementation caused by bleeding due to infiltration of the small intestine by a diffuse large B-cell lymphoma. The diagnostic workup as well as the differential diagnosis and therapeutic approach in such rare cases will be outlined. [ABSTRACT FROM AUTHOR]

We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. [ABSTRACT FROM AUTHOR]

Massive lower gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection, in a critically ill patient. We report a 69-year-old man, known to have chronic obstructive pulmonary disease on ventilator, who developed sudden onset abdominal pain and massive lower GI bleeding. Due to uncontrolled bleeding, the patient was explored surgically. Bleeding from ileum was evident. The affected segment of the ileum was resected. Histology confirmed the diagnosis of CMV enteritis and Gancyclovir was initiated. On the following days, his physical state had improved and bleeding was resolved. [ABSTRACT FROM AUTHOR]