First Year Fellows Endoscopy Course (July 28-29) | 2023-8-Therapeutic

8-Therapeutic_Colonoscopy

Pdf Summary

This document provides an overview of therapeutic colonoscopy, focusing on lower GI bleeding, polypectomy, colonoscopic decompression, and complications. Lower GI bleeding is defined as bleeding that lasts less than three days and may result in hemodynamic instability, anemia, and the need for blood transfusion. Etiologies of lower GI bleeding include diverticular bleeding, ischemic colitis, angioectasia, hemorrhoids, colorectal neoplasia, and more. The best next step in management for a 75-year-old female presenting with painless lower GI bleeding is a bowel prep followed by colonoscopy.<br /><br />Colonoscopy is the preferred test for acute lower GI bleeding as it allows for precise localization, therapy, and a diagnostic yield of 45-90%. The document also discusses the management of severe hematochezia and the timing of colonoscopy in acute lower GI bleeding. Therapeutic options during colonoscopy include injection therapy, thermal therapy, and mechanical therapy.<br /><br />Polypectomy techniques include cold biopsy, cold snare, hot snare/electrocautery, hot biopsy, and EMR with submucosal "saline lift". The document also provides tips for polypectomy of large polyps and the importance of recognizing the limits of your skills.<br /><br />Other topics covered include the use of tattooing to demarcate lesions, post-polypectomy complications such as bleeding and perforation, and the management of post-polypectomy coagulation syndrome.<br /><br />The document concludes with information on colonic decompression for indications such as distended colon and techniques for decompression. It emphasizes the importance of knowing the options for endoscopic treatment, avoiding complications, and knowing how to manage complications if they occur during colonoscopy.

Keywords

therapeutic colonoscopy

lower GI bleeding

polypectomy

colonoscopic decompression

complications

diverticular bleeding

ischemic colitis

angioectasia

hemorrhoids

colorectal neoplasia