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Urgent endoscopy in lower gastrointestinal bleeding
  1. J L H WONG
  1. H R DALTON
  1. Gastroenterology Unit, Royal Cornwall Hospital
  2. Truro, Cornwall TR1 3LJ, UK
  3. Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK
  1. Dr J L H Wong. johnlhw{at}netscape.net

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Endoscopy plays an important role in the management of acute gastrointestinal bleeding. Therapeutic endoscopy in upper gastrointestinal bleeding helps to achieve haemostasis, decreases the risk of rebleeding and the need for surgery. Jensenet al have examined whether urgent diagnostic and therapeutic endoscopy in lower gastrointestinal bleeding results in similar benefits.1 They report that the endoscopic stigmata of haemorrhage seen in upper gastrointestinal bleeding (that is, active bleeding, non-bleeding visible vessels, or adherent clots) also appear to predict the risk of rebleed in patients who have bled from diverticular disease. Therapeutic intervention with epinephrine injection or bipolar coagulation in patients with these stigmata was beneficial with decreased rebleeding rates, leading to avoidance of surgical intervention.

The study only examined patients with identifiable diverticular disease and haematochezia. Although diverticular bleeding is the commonest cause of acute lower gastrointestinal bleeding, the majority of these (70–80%) stop bleeding spontaneously2 and the mortality of diverticular bleeding is low3 compared with bleeding due to peptic ulceration. The benefits in this study need to be interpreted in the context of this …

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