[Acute lower gastrointestinal bleeding--an evidence-based algorithm for diagnosis and treatment]

Vorburger, S A; Candinas, D; Egger, B (2006). [Acute lower gastrointestinal bleeding--an evidence-based algorithm for diagnosis and treatment]. Therapeutische Umschau, 63(5), pp. 301-9. Bern: Huber

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Novel means to locate and treat lower gastrointestinal bleeding (lGB) allow to reduce the rate of required surgical interventions and help to limit the extend of resection. The risk stratification of patients with lGB is the primary step of our recommended treatment algorithm. Accordingly, risk stratifying instruments, which are only partly validated up to now, are gaining significance in lGB. Whereas, gastro-duodenoscopy and colonoscopy prior to angiography or scintigraphy are established diagnostic tools, capsule enteroscopy offers a novel approach to hemodynamic stable patients with lGB that are difficult to localize. With its every increasing sensitivity, Angio-Computer Tomography is likely to replace scintigraphy and diagnostic angiography in the very near future. In addition, recent advances in superselective microembolisation have been shown to have the potential rendering surgical interventions in a majority of patients with acute lGB unnecessary. The extend of required surgical resection is largely dependent on the success to localize the bleeding source of prior diagnostics. Only if the source is identified, a limited segmental resection should be performed. Should surgery be required, we suggest to maintain the effort to localize the bleeding, either by prior laparoscopy and/or by intraoperative entero-colonoscopy. Eventually, if the source of bleeding remains unclear total colectomy with ileorectal anastomosis represents the procedure of choice in patients with acute lGB.

Item Type:	Journal Article (Further Contribution)
Division/Institute:	04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
UniBE Contributor:	Vorburger, Stephan, Candinas, Daniel, Egger, Bernhard
ISSN:	0040-5930
ISBN:	16739888
Publisher:	Huber
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:49
Last Modified:	05 Dec 2022 14:15
PubMed ID:	16739888
URI:	https://boris.unibe.ch/id/eprint/20475 (FactScience: 3935)