ASGE Recognized Industry Associate (ARIA) Training Program OPEN | April 2022-Large Intestine: Lower GI Bleeding, Colorectal Cancer and Diverticulosis

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This document focuses on three conditions related to the large intestine: lower GI bleeding, colorectal cancer, and diverticulosis.<br /><br />Lower GI bleeding occurs when there is bleeding in the gastrointestinal tract located after the Ligament of Treitz. Symptoms include bright red blood per rectum (hematochezia), black, tarry colored stools (melena), symptomatic anemia, lightheadedness, syncope, shortness of breath, and chest pain. Causes include anatomic, vascular, inflammatory, and malignancy-related factors such as diverticulosis, angiodysplasia, ischemic colitis, and colon cancer. Diagnosis involves the exclusion of upper GI bleeding through techniques like nasogastric lavage and upper endoscopy. Management includes resuscitation, volume resuscitation, and hemostasis techniques like hemostatic clips, argon plasma coagulation, and epinephrine injection. Colonoscopy is commonly used to diagnose and provide hemostasis for bleeding diverticula.<br /><br />Colorectal cancer is cancer located in the colon or rectum. It is one of the most common cancers in the U.S. with a lifetime risk of around 5%. The natural progression of colorectal cancer involves the development of hyper-proliferation, small and large adenomatous polyps, high-grade dysplasia, and finally invasive cancer. Clinical presentations vary, but can include asymptomatic cases, cases with suspicious symptoms and signs, and cases that emerge with obstruction or peritonitis. Screening for colorectal cancer is recommended for individuals aged 50 and above, individuals with a family history of colorectal cancer, those with inherited colorectal cancer syndrome, and individuals with inflammatory bowel disease. Screening tests include guaiac-based fecal occult blood tests, fecal immunochemical tests, stool DNA tests, double-contrast barium enemas, flexible sigmoidoscopies, colonoscopies, and CT colonographies. Treatment options depend on the stage and location of the tumor, and can include surgical resection, chemotherapy, and palliative care.<br /><br />Diverticulosis refers to the presence of outpouchings of the colonic mucosa and submucosa. It is usually an incidental finding on diagnostic tests and is located throughout the colon, with the left side being more commonly affected than the right. Complications of diverticulosis include diverticulitis, which is inflammation of a diverticulum, and diverticular bleeding. Diverticulitis can be diagnosed through computed tomography (CT) scans and can be managed with antibiotics. Diverticular bleeding occurs when an artery erodes into the base of the diverticulum, usually presenting as painless rectal bleeding. Treatment options for diverticular bleeding include colonoscopy, angiography, and surgery. Other conditions discussed briefly in the document include hemorrhoids and their causes, diagnosis, and treatment options.

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Arnold Markowitz, MD, FASGE

Keywords

lower GI bleeding

colorectal cancer

diverticulosis

gastrointestinal tract

hematochezia

melena

symptomatic anemia

colonoscopy

colonic mucosa

diverticulitis