ASGE Standards of Practice Committee member Shabana F. Pasha, MD discusses the newest ASGE guideline: “The role of endoscopy in the patient with lower GI bleeding.”
This guideline is a product of the ASGE Standards of Practice Committee. It provides a summary of the existing literature on the different etiologies, classification, and clinical presentation of lower GI bleeding (LGIB), and its management. Based upon a critical review of currently available treatment options and outcomes, we provide recommendations on endoscopic management of LGIB.
The ASGE considered it important to update this guideline due to several reasons. LGIB accounts for 20% to 30% of all patients presenting with major GI bleeding, with approximately 36 per 100,000 adults hospitalized for LGIB annually in the United States. The earlier designation of LGIB as all sources of bleed distal to the ligament of Treitz , has now been modified to include only colonic sources . Endoscopic treatment is the primary modality in the management of LGIB, with angiography and surgery reserved for patients with persistent or refractory bleeding. There have been several advances in endoscopic management of LGIB since the last update. There is data to support the role of urgent colonoscopy for the diagnosis and management of patients with severe hematochezia. In addition, there is emerging data to show that hemostatic clips may be as effective as thermal techniques for endoscopic treatment of LGIB.
This guideline is an educational tool to assist endoscopists in providing care to patients with LGIB. We provide recommendations and an algorithmic approach to guide management based upon the clinical presentation and acuity of bleed. The recommendations in the guideline are based on the reviewed literature on evaluation and management of LGIB, and are graded on the strength of the supporting evidence. The strength of the individual recommendations is based on the aggregate evidence quality and an assessment of the anticipated benefits and harms of the different interventions. Clinical decisions in any particular case should involve a complex analysis of the patient’s condition and available options for treatment.
Find the guideline online.
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