ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand) | 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 bleeding (LGIB). Dr. Jennifer Christie discusses various topics related to LGIB, including diverticular bleeding, colon cancer bleeding, hemostatic powder for LGIB, iatrogenic bleeding, and clipping pedunculated polyps.<br /><br />In relation to diverticular bleeding, Dr. Christie highlights the different rates of rebleeding associated with different treatment methods. Coagulation (bipolar) and TTS clipping both have a rebleeding rate of 24%, while band ligation has a lower rebleeding rate of 9%.<br /><br />The use of hemostatic powder for LGIB is also discussed, with Dr. Christie noting that it provides immediate hemostasis in over 98% of cases. However, there is a 10% rebleeding rate associated with its use, and it has been observed that 73% of post-polypectomy bleeding cases involve the use of hemostatic powder.<br /><br />Iatrogenic bleeding, which refers to bleeding caused by medical intervention, is another topic covered. Dr. Christie does not provide further details on this topic in the summary.<br /><br />The discussion also explores the question of when to clip a pedunculated polyp. Two perspectives are presented: one in favor of pre-clipping before snaring and one against it. Those in favor argue that pre-clipping reduces immediate bleeding, with a lower rate of 2.5% compared to 10.9% for snaring without pre-clipping. Those against pre-clipping suggest that pure forced coagulation can achieve the same results. Additionally, if the resection is too close to the head of the polyp, there is a risk of a positive resection margin for a malignant polyp that would have been negative if resected closer to the colon wall.<br /><br />Overall, this video case discussion provides insights into various aspects of LGIB, including different treatment methods for diverticular bleeding, the efficacy and limitations of hemostatic powder, iatrogenic bleeding, and the debate surrounding pre-clipping before snaring pedunculated polyps.

Keywords

lower gastrointestinal bleeding

diverticular bleeding

hemostatic powder

iatrogenic bleeding

clipping pedunculated polyps

rebleeding rate

band ligation

coagulation

post-polypectomy bleeding

pre-clipping