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  1. Kathryn Oakland1,
  2. Jonathan Hoare2
  1. 1 Digestive Diseases Department, HCA Healthcare UK, London, UK
  2. 2 Gastroenterology, Imperial College NHS Trust, London, UK
  1. Correspondence to Dr Jonathan Hoare, Gastroenterology, Imperial College NHS Trust, London W21NY, UK; j.hoare{at}

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We thank Dr Leeds et al for their interest and comments1 on the British Society of Gastroenterology guideline on the diagnosis and management of acute lower gastrointestinal bleeding (LGIB).2 They are quite correct to highlight the difference in evidence supporting therapeutic endoscopy in LGIB as opposed to upper. There is only one randomised trial that directly compared timing of colonoscopy in patients hospitalised with LGIB, which as the authors’ state demonstrated no difference in clinical outcomes, however, the trial was terminated before the required sample size had been reached.3 Pooled analysis in a systematic review of non-randomised studies demonstrated that early colonoscopy was associated with higher diagnostic and therapeutic yields and most importantly a shorter length of …

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  • Contributors Both authors contributed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KO has received editorial fees for reviews on the same topic.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.