Lower gastrointestinal bleeding endoscopic intervention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Endoscopic Intervention

• Endoscopic Intervention is the best initial step in the management of lower gastrointestinal bleeding and considered as the most direct and effective approach.
• Indicated in all cases of gastrointestinal bleeding.
• Common complications include perforation of the luminal wall, resulting in peritonitis and sepsis and failure to control bleeding.

Argon plasma coagulation

• Argon plasma coagulation uses ionized argon gas to causes tissue coagulation. A high-frequency electrical current is conducted through the gas to ionize it.
• Argon plasma coagulation is safe and easier to use
• Submucosal saline cushions are administered prior to APC treatment to reduce the risk of deeper wall injury.
• Coagulopathies has to be corrected before APC treatment.

Bipolar or Heater probe

• Bipolar or Heater probe provides controlled coagulation by a applying a heater probe to site of bleeding

Other Surgical options	Procedure	Indications	Complications	Comments
Endoscopic Intervention	Under sedation, a fiberoptic instrument is inserted for inspection of the mucosa to identify a bleeding site Further instrumentation inserted through the scope may aid in stopping the bleed.	All cases of gastrointestinal bleeding.	Perforation of the luminal wall, resulting in peritonitis and sepsis. Failure to control bleeding.	Best initial step Most direct and effective approach.
Argon plasma coagulation	Argon plasma coagulation uses ionized argon gas to causes tissue coagulation. A high-frequency electrical current is conducted through the gas to ionize it.	Variety of causes of LGIB	Failure to control bleeding Full bowel preparation is required to prevent explosion from colonic gas, which is combustible APC causes limited depth coagulation and should be performed with caution in the right colon as it is thin-walled and more likely to perforate.	APC is safe and easy to use To reduce the risk of deeper wall injury, submucosal saline cushions have been used prior to APC treatment Patients with coagulopathy do worse with APC unless the coagulopathy is corrected
Bipolar or Heater probe	Provides controlled coagulation by a applying a heater probe to site of bleeding.	May be used alone or in combination with other modalities for control of LGIB due to a variety of causes	Failure to control bleeding Thermal necrosis and recurrent bleeding (eg, at polypectomy site). If necrosis extends to submucosal vessels, significant bleeding can result Perforation	Failure to control bleeding Thermal necrosis and recurrent bleeding (eg, at polypectomy site). If necrosis extends to submucosal vessels, significant bleeding can result Perforation
Endoloops and hemoclips
Interventional radiology