Year 2022 / Volume 114 / Number 10
Letter
Is urgent colonoscopy without bowel preparation really useful? Colonoscopy without bowel preparation

632-633

DOI: 10.17235/reed.2022.8850/2022

Catarina Correia, Nuno Almeida, Paulo Souto, Pedro Figueiredo,

Abstract
Acute lower gastrointestinal bleeding (LGIB) is a common disorder which involves many problems in diagnosis and treatment. Concerning colonoscopy in an urgent context, guidelines are very specific in stating that unprepared colonoscopy has no place in the evaluation of patients with suspected LGIB. The purpose of this study was to evaluate the diagnosis and therapeutic effectiveness of urgent colonoscopy, without prior bowel preparation, in patients admitted at the hospital with acute LGIB. Were included 132 patients consecutively admitted at the Emergency Department for LGIB and who had undergone colonoscopy without prior bowel preparation. Despite the lack of preparation, cecal observation was possible in 10 patients (7.6%). More than two thirds of the diagnoses (69.1%) were established with the performance of just a left colonoscopy. In 63.6% of patients, a definitive diagnosis was established using this initial approach. In 35.6% of the individuals, biopsies were performed, which allowed the establishment of a histological diagnosis. Additionally, in 14 patients (16.7%) an active hemorrhagic focus was identified, and endoscopic hemostasis was performed. None of these 14 patients required additional procedures during the hospital stay. Only in 21 patients the initial colonoscopy was inconclusive and, consequently, it was necessary to repeat it after anterograde preparation. Even in these cases, no diagnosis was reached in 33.3%. This study revealed that unprepared colonoscopy in an urgent context could a useful procedure which allows an adequate guidance in more than half of the patients.
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References
[1] Ohyama T, Sakurai Y, Ito M, et al. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion 2000;61:189–92.
[3] Triantafyllou K, Gkolfakis P, Gralnek IM, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021.
[3] Rossini FH, Perrari A, Spandore M, et al. Emergency colonoscopy. World J Surg 1989;13:190–192.
[4] Rockall TA, Logan RF, Devlin HB NT. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National audit of acute upper gastrointestinal haemorrhage. Lancet 1996;347:1138–40.
[5] Green BT, Rockey DC, Portwood G, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: A randomized controlled trial. Am J Gastroenterol 2005;100:2395–402.
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Correia C, Almeida N, Souto P, Figueiredo P. Is urgent colonoscopy without bowel preparation really useful? Colonoscopy without bowel preparation . 8850/2022


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Publication history

Received: 08/04/2022

Accepted: 12/04/2022

Online First: 26/04/2022

Published: 07/10/2022

Article Online First time: 18 days

Article editing time: 182 days


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