Post written by Mauro Manno, MD, from the Gastroenterology and Digestive Endoscopy Unit, Azienda USL, Modena, Italy.

A 70–year-old man with history of chronic atrial fibrillation ongoing anticoagulant therapy was hospitalized for hemorrhagic shock and severe anemia, secondary to massive LGIB. Resuscitation with fluids and blood transfusions was performed. The novel 1-liter PEG+ASC solution (Plenvu, Norgine) was used for bowel cleansing, administered in 2 hours (1 hour for PEG-ASC solution and 1 hour for water). Urgent IC was performed 2 hours after the end of solution intake. We obtained excellent bowel preparation (Boston-Bowel-Preparation-Scale 9), and the diagnosis of oozing bleeding vessel in cecum, type 2a Dieulafoy lesion, was allowed and successfully treated with 5 through-the-scope clips.

In cases of acute lower gastrointestinal bleeding, the diagnostic and therapeutic yield of ileo-colonoscopy can range from 48 to 90%. One-liter of PEG-ASC solution has been administered in patients in critical condition (ie, hemorrhagic shock due to massive LGIB), showing high-performance level, allowing both challenging diagnoses (Dieulafoy lesion of the cecum) and effective endoscopic hemostasis.

In more frail patients, a prompt diagnosis and treatment can be of paramount importance on the final clinical outcome. One-liter of PEG-ASC bowel prep allowed, in this case, us to perform urgent ileo-colonoscopy within 8 hours of hospital admission. The amount of time gained (2 hours) may be clinically relevant in unstable patients, or in patients with lots of comorbidities (especially if cardiovascular), such in this case. Waiting for RCT, the use of 1-liter PEG-ASC solution can be considered when time saving is essential for the patient’s outcome.

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