First Year Fellows Endoscopy Course (August 7 - 8)

8-Therapeutic_Colonoscopy
Pdf Summary
This document provides information on therapeutic colonoscopy and management techniques for lower gastrointestinal bleeding (LGIB) and polyp removal. <br /><br />The definition of acute LGIB is bleeding from a source distal to the ligament of Treitz, lasting less than three days, and potentially leading to hemodynamic instability or the need for blood transfusion. Etiologies of LGIB include diverticular bleeding, ischemic colitis, angioectasia, hemorrhoids, colorectal neoplasia, and more.<br /><br />When managing severe hematochezia, urgent colonoscopy is recommended. To prepare for colonoscopy in acute LGIB cases, a rapid purge with polyethylene glycol (PEG) solutions should be performed cautiously to avoid aspiration and fluid overload.<br /><br />Colonoscopy is the preferred diagnostic tool for acute LGIB due to its precise localization and therapeutic capabilities. However, it requires bowel preparation and may have limited visibility in cases of poor prep and active bleeding.<br /><br />Therapeutic options during colonoscopy include injection therapy with epinephrine, thermal therapy with bipolar cautery or argon plasma coagulation, and mechanical therapy with endoclips.<br /><br />Non-endoscopic management options for acute LGIB include tagged red blood cell (RBC) scan, multidetector helical CT angiography, angiography for unstable patients, and surgery (rarely required).<br /><br />Diverticular bleeding can often resolve spontaneously but may require thermal contact modalities, endoscopic clipping, or endoscopic band ligation for treatment.<br /><br />Vascular lesions such as angioectasias can be effectively treated with electrocautery or non-contact thermal therapy (APC).<br /><br />Polypectomy techniques include cold biopsy, cold snare, hot snare/electrocautery, hot biopsy, and EMR with submucosal "saline lift." Proper preparation, equipment selection, and technique are crucial for successful polyp removal.<br /><br />Complications of polypectomy include bleeding, perforation, retroperitoneal abscess, and subcutaneous emphysema. Prompt management, such as endoscopic therapy, angiography, or surgery, may be required for post-polypectomy hemorrhage.<br /><br />Other topics mentioned in the document include post-polypectomy coagulation syndrome, barotrauma, diverticulosis perforation, and colonic decompression techniques for indications such as distended colon or pseudo-obstruction.<br /><br />Overall, this document emphasizes the importance of proper management techniques and awareness of complications during therapeutic colonoscopy.
Keywords
therapeutic colonoscopy
lower gastrointestinal bleeding
LGIB
polyp removal
acute LGIB
diverticular bleeding
ischemic colitis
angioectasia
hemorrhoids
colorectal neoplasia