ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Christie_UGI bleed and Lower GI Bleed

Christie_UGI bleed and Lower GI Bleed_LGIB

Pdf Summary

This video case discussion focuses on lower gastrointestinal (GI) bleeding. The presenter, Dr. Jennifer Christie, discusses various aspects of GI bleeding, including diverticular bleeding, colon cancer brisk bleeding, hemostatic powder for LGIB, iatrogenic bleeding, and the use of clipping in pedunculated polyps. <br /><br />First, Dr. Christie provides information on diverticular bleeding. She mentions three different cases of active diverticular bleeding and discusses the rebleeding rates associated with different treatment methods, such as coagulation, TTS clipping, and band ligation. The source cited for this information is Digestive Endoscopy 2020; 32: 240–250.<br /><br />Next, she discusses colon cancer brisk bleeding that occurs after a biopsy. She mentions the use of hemostatic powder, which has shown immediate hemostasis in over 98% of cases. However, rebleeding has been observed in 10% of cases, with 73% of post-polypectomy bleeding cases being related to this type of bleeding. The source cited for this information is Gastrointest Endosc, 89 (2019), pp. 865-871.<br /><br />Dr. Christie then talks about iatrogenic bleeding, which refers to bleeding caused by medical procedures. She highlights the importance of identifying and managing this type of bleeding during endoscopic procedures.<br /><br />Lastly, she discusses the use of clipping in pedunculated polyps and the debate surrounding pre-clipping before snaring. Some argue that pre-clipping reduces immediate bleeding compared to snaring alone, with a lower incidence of bleeding at 2.5% versus 10.9%. However, others argue that pure forced coagulation can achieve the same result. Additionally, if resection is too close to the head of the polyp, there may be a positive resection margin for a malignant polyp that would have been negative if resected closer to the colon wall. The source cited for this information is GIE 2021 Jul;94(1):148-154.<br /><br />In summary, this video case discussion provides insights into various aspects of lower GI bleeding, including diverticular bleeding, colon cancer brisk bleeding, hemostatic powder use, iatrogenic bleeding, and the use of clipping in pedunculated polyps.

Keywords

lower GI bleeding

diverticular bleeding

colon cancer brisk bleeding

hemostatic powder

TTS clipping

band ligation

iatrogenic bleeding

endoscopic procedures

clipping in pedunculated polyps

pre-clipping before snaring