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Concerns regarding the recommendations of the British Society of Gastroenterology’s lower GI bleeding guidelines
  1. Ajay M Verma1,
  2. Neeraj Bhala2,
  3. Andrew Chilton1,
  4. Benjamin R Disney3
  1. 1Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
  2. 2Gastroenterology and Liver Units, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Ajay M Verma, Department of Digestive Diseases, Kettering General Hospital, Kettering NN16 8UZ, UK; ajay.verma{at}

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We are writing with regard to the recently published British Society of Gastroenterology (BSG) lower GI bleeding (LGIB) guidelines.1 We have significant concerns about some of the recommendations.

The quick reference flowchart suggests that patients with stable LGIB (shock index <1), classed as having a major (risk scored) bleed, should be admitted for a lower GI endoscopy on the next available list. This is inconsistent with the main body of the guideline which states: a colonoscopy on the next available list. We find this recommendation concerning, particularly as it has implications for endoscopy unit resources, inpatient services, and patient safety. Delivering urgent inpatient colonoscopy in this cohort of patients is logistically challenging.

Is a colonoscopy necessary for all? The acute LGIB national audit showed that 73.9% of patients presented with rectal …

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