Obscure Gastrointestinal Bleeding Due to Colonic Source
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Colon (J Anderson, Section Editor)
Obscure Gastrointestinal Bleeding Due to Colonic Source Robert W. Klapheke, MD1,2 Ethan Bortniker, MD, MBA1,2,* Address 1 Veterans Affairs San Diego Healthcare System, San Diego, CA, USA *,2 Division of Gastroenterology, University of California—San Diego, 9500 Gilman Drive, MC 0956, La Jolla, CA, 92037, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Colon Keywords Gastrointestinal bleeding I Obscure bleeding I Lower gastrointestinal bleeding I Colonic bleeding I Diverticular bleeding I Colonoscopy
Abstract Purpose of review Acute GI bleeding is a prevalent condition responsible for significant morbidity, mortality, and overall health care burden in the United States and globally. Obscure GIB is defined as recurrent or persistent evidence of blood loss after negative endoscopic assessment. The purpose of this review is to further examine colonic sources of obscure GI bleeding with regard to epidemiology, diagnosis, therapy, rebleeding rate, and areas in need of further study. Recent findings Newer diagnostic modalities like video capsule endoscopy have shown the importance of continued investigation of colonic bleeding after negative colonoscopy, but the risk of rebleeding has not changed significantly over time. New practice recommendations for lower GI bleeding may increase the yield of evaluation. Summary Obscure lower GI bleeding causes significant morbidity even though it is a common problem usually caused by common colonic lesions, including diverticulosis, gastrointestinal angiodysplastic lesions, colitis, or colon cancer.
Introduction Acute gastrointestinal bleeding (GIB) causes approximately 300,000 hospitalizations annually in the United States [1, 2]. GIB can be generally attributed to an upper GI, small bowel, or colon source. Upper GI source is defined as a culprit lesion located anywhere from the
esophagus to the duodenum proximal to the ligament of Treitz. Small bowel sources are located distal to the ligament of Treitz extending to the terminal ileum. Colonic bleeding for the purposes of this paper is considered interchangeable with the term lower GI bleeding
Colon (J Anderson, Section Editor) (LGIB), which accounts for 20–25% of overall cases of acute GIB [3] In-hospital mortality from LGIB is estimated at 1.1–2.9% [2, 4] with an associated mean cost of hospitalization of $11,892 and average length of stay of 5.1 days [4]. Following urgent colonoscopy for evaluation of acute LGIB, the rates of early rebleeding occurring prior to hospital discharge and late rebleeding occurring after discharge are reported to be 22 and 16%, respectively [5, 6]. General standard of care in investigating GIB includes esophagogastroduodenoscopy and/or colonoscopy [7]. If these initial assessments are negative but suspicion for a GI source for blood loss remains high, video capsule endoscopy (VCE) and additional abdominal imaging techniques (e.g. CT enterography, angiog
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