Lower gastrointestinal bleeding diagnostic study of choice: Difference between revisions

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{{CMG}} {{AE}}
{{CMG}} {{AE}}
== Overview ==
== Overview ==
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
[[Colonoscopy]] is the gold standard test for the diagnosis of lower gastrointestinal bleeding. However, [[endoscopy]] is the investigation of choice in cases of lower gastrointestinal bleeding caused by [[ischemic colitis]].
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].  
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.
 
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
*[[Colonoscopy]] is recommended as the first-line investigation in patients presenting with LGIB.<ref name="pmid22468081">{{cite journal |vauthors=Lhewa DY, Strate LL |title=Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=18 |issue=11 |pages=1185–90 |year=2012 |pmid=22468081 |pmc=3309907 |doi=10.3748/wjg.v18.i11.1185 |url=}}</ref><ref name="pmid24143306">{{cite journal |vauthors=Jang BI |title=Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia? |journal=Clin Endosc |volume=46 |issue=5 |pages=476–9 |year=2013 |pmid=24143306 |pmc=3797929 |doi=10.5946/ce.2013.46.5.476 |url=}}</ref><ref name="pmid28174123">{{cite journal |vauthors=Kouanda AM, Somsouk M, Sewell JL, Day LW |title=Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis |journal=Gastrointest. Endosc. |volume=86 |issue=1 |pages=107–117.e1 |year=2017 |pmid=28174123 |doi=10.1016/j.gie.2017.01.035 |url=}}</ref><ref name="pmid21131933">{{cite journal |vauthors=Strate LL |title=Editorial: Urgent colonoscopy in lower GI bleeding: not so fast |journal=Am. J. Gastroenterol. |volume=105 |issue=12 |pages=2643–5 |year=2010 |pmid=21131933 |doi=10.1038/ajg.2010.401 |url=}}</ref><ref name="pmid24060518">{{cite journal |vauthors=Navaneethan U, Njei B, Venkatesh PG, Sanaka MR |title=Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study |journal=Gastrointest. Endosc. |volume=79 |issue=2 |pages=297–306.e12 |year=2014 |pmid=24060518 |doi=10.1016/j.gie.2013.08.001 |url=}}</ref><ref name="pmid9697900">{{cite journal |vauthors=Chaudhry V, Hyser MJ, Gracias VH, Gau FC |title=Colonoscopy: the initial test for acute lower gastrointestinal bleeding |journal=Am Surg |volume=64 |issue=8 |pages=723–8 |year=1998 |pmid=9697900 |doi= |url=}}</ref><ref name="pmid19881516">{{cite journal |vauthors=Barnert J, Messmann H |title=Diagnosis and management of lower gastrointestinal bleeding |journal=Nat Rev Gastroenterol Hepatol |volume=6 |issue=11 |pages=637–46 |year=2009 |pmid=19881516 |doi=10.1038/nrgastro.2009.167 |url=}}</ref>
===Advantages===
The advantages of [[colonoscopy]] as an initial investigation include:
*The ability to accurately locate and visualize the site of the bleeding, and the potential for therapeutic intervention.
===Disadvantages===
*Disadvantages of [[colonoscopy]] include poor visualization in an unprepared colon.
*Risk of [[fluid overload]] in the acutely ill patient receiving rapid bowel preparation.
===Interpretation===
*The [[sensitivity]] of [[colonoscopy]] in detecting [[lesions]] such as [[angiodysplasia]] depends on good bowel preparation, and it is estimated to exceed 80%.
*The [[sensitivity]] of [[colonoscopy]] in detecting bleeding lesions, however, is estimated at 48% to 90%. Therefore, a bleeding site is frequently not identified.
*Despite the disadvantages, complete [[colonoscopy]] can be carried out in more than 95% of patients, and a source of bleeding can be identified by [[colonoscopy]] in 74% to 82% of patients.
*There is a risk of [[bowel perforation]] with [[colonoscopy]], especially in patients with [[colitis]].


===== Template statements =====
==Endoscopy==
=== Gold standard/Study of choice: ===
*[[Endoscopy]] is the investigation of choice for [[ischemic colitis]]; however, it is not recommended to perform [[endoscopy]] in a patient with severe abdominal pain or [[peritonitis]].<ref name="pmid24918002">{{cite journal |vauthors=Sonnenberg A |title=Timing of endoscopy in gastrointestinal bleeding |journal=United European Gastroenterol J |volume=2 |issue=1 |pages=5–9 |year=2014 |pmid=24918002 |pmc=4040802 |doi=10.1177/2050640613518773 |url=}}</ref><ref name="pmid21286288">{{cite journal |vauthors=Whitlow CB |title=Endoscopic treatment for lower gastrointestinal bleeding |journal=Clin Colon Rectal Surg |volume=23 |issue=1 |pages=31–6 |year=2010 |pmid=21286288 |pmc=2850164 |doi=10.1055/s-0030-1247855 |url=}}</ref>
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*In cases in which no source of bleeding is seen on [[colonoscopy]], [[esophagogastroduodenoscopy]] should be undertaken, as occasionally, brisk UGIB increases transit time and presents as blood per rectum.<ref name="pmid18796089">{{cite journal |vauthors=Wong Kee Song LM, Baron TH |title=Endoscopic management of acute lower gastrointestinal bleeding |journal=Am. J. Gastroenterol. |volume=103 |issue=8 |pages=1881–7 |year=2008 |pmid=18796089 |doi=10.1111/j.1572-0241.2008.02075.x |url=}}</ref>
* The following result of [gold standard test] is confirmatory of [disease name]:
*[[Endoscopic]] evaluation of the [[small bowel]] may include a combination of [[endoscopic]] techniques, such as wireless [[capsule endoscopy]] and [[small bowel]] [[enteroscopy]] (double balloon, push or [[spiral]] [[enteroscopy]]).
** Result 1
*These modalities are often used if [[colonoscopy]] and [[esophagogastroduodenoscopy]] have failed to identify the source of gastrointestinal blood loss.
** Result 2
*Advantages of [[capsule endoscopy]] are that it is technically easier to use, is noninvasive, and does not require [[sedation]]. However, it lacks [[endoscopic]] access for therapeutic intervention.
* The [name of investigation] should be performed when:
*[[Capsule endoscopy]] has a higher diagnostic yield in bleeding patients than [[enteroscopy]], 56% and 26% respectively, and is, therefore, often performed before [[enteroscopy]]. If a bleeding lesion is visualized, then endoscopic intervention can be considered
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==CT angiography (CTA)==
*[[CT angiography|CTA]] may be a more appropriate first-line investigation in patients with abdominal pain or suspected [[peritonitis]].<ref name="pmid28070213">{{cite journal |vauthors=Clerc D, Grass F, Schäfer M, Denys A, Demartines N, Hübner M |title=Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both? |journal=World J Emerg Surg |volume=12 |issue= |pages=1 |year=2017 |pmid=28070213 |pmc=5215140 |doi=10.1186/s13017-016-0112-3 |url=}}</ref>


==References==
==References==
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
{{reflist|2}}
* For information on how to add references into your page, click [[Adding References to Articles|here]].

Latest revision as of 17:49, 29 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Colonoscopy is the gold standard test for the diagnosis of lower gastrointestinal bleeding. However, endoscopy is the investigation of choice in cases of lower gastrointestinal bleeding caused by ischemic colitis.

Diagnostic Study of Choice

Advantages

The advantages of colonoscopy as an initial investigation include:

  • The ability to accurately locate and visualize the site of the bleeding, and the potential for therapeutic intervention.

Disadvantages

  • Disadvantages of colonoscopy include poor visualization in an unprepared colon.
  • Risk of fluid overload in the acutely ill patient receiving rapid bowel preparation.

Interpretation

Endoscopy

CT angiography (CTA)

  • CTA may be a more appropriate first-line investigation in patients with abdominal pain or suspected peritonitis.[11]

References

  1. ↑ Lhewa DY, Strate LL (2012). "Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding". World J. Gastroenterol. 18 (11): 1185–90. doi:10.3748/wjg.v18.i11.1185. PMC 3309907. PMID 22468081.
  2. ↑ Jang BI (2013). "Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia?". Clin Endosc. 46 (5): 476–9. doi:10.5946/ce.2013.46.5.476. PMC 3797929. PMID 24143306.
  3. ↑ Kouanda AM, Somsouk M, Sewell JL, Day LW (2017). "Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis". Gastrointest. Endosc. 86 (1): 107–117.e1. doi:10.1016/j.gie.2017.01.035. PMID 28174123.
  4. ↑ Strate LL (2010). "Editorial: Urgent colonoscopy in lower GI bleeding: not so fast". Am. J. Gastroenterol. 105 (12): 2643–5. doi:10.1038/ajg.2010.401. PMID 21131933.
  5. ↑ Navaneethan U, Njei B, Venkatesh PG, Sanaka MR (2014). "Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study". Gastrointest. Endosc. 79 (2): 297–306.e12. doi:10.1016/j.gie.2013.08.001. PMID 24060518.
  6. ↑ Chaudhry V, Hyser MJ, Gracias VH, Gau FC (1998). "Colonoscopy: the initial test for acute lower gastrointestinal bleeding". Am Surg. 64 (8): 723–8. PMID 9697900.
  7. ↑ Barnert J, Messmann H (2009). "Diagnosis and management of lower gastrointestinal bleeding". Nat Rev Gastroenterol Hepatol. 6 (11): 637–46. doi:10.1038/nrgastro.2009.167. PMID 19881516.
  8. ↑ Sonnenberg A (2014). "Timing of endoscopy in gastrointestinal bleeding". United European Gastroenterol J. 2 (1): 5–9. doi:10.1177/2050640613518773. PMC 4040802. PMID 24918002.
  9. ↑ Whitlow CB (2010). "Endoscopic treatment for lower gastrointestinal bleeding". Clin Colon Rectal Surg. 23 (1): 31–6. doi:10.1055/s-0030-1247855. PMC 2850164. PMID 21286288.
  10. ↑ Wong Kee Song LM, Baron TH (2008). "Endoscopic management of acute lower gastrointestinal bleeding". Am. J. Gastroenterol. 103 (8): 1881–7. doi:10.1111/j.1572-0241.2008.02075.x. PMID 18796089.
  11. ↑ Clerc D, Grass F, Schäfer M, Denys A, Demartines N, Hübner M (2017). "Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?". World J Emerg Surg. 12: 1. doi:10.1186/s13017-016-0112-3. PMC 5215140. PMID 28070213.
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