First Year Fellows Endoscopy Course (July 30-31) | 2023-8-Therapeutic

8-Therapeutic_Colonoscopy

Pdf Summary

This document provides an overview of therapeutic colonoscopy, including the management of lower gastrointestinal (GI) bleeding and polypectomy complications. It defines acute lower GI bleeding as a source of bleeding distal to the IC valve and lasting less than three days. The etiologies of lower GI bleeding include diverticular bleeding, ischemic colitis, angioectasia, hemorrhoids, colorectal neoplasia, postpolypectomy bleeding, and others.<br /><br />In the case of a 75-year-old female presenting with painless bright red blood per rectum (BRBPR) and no history of GI bleeding, the best next step in management would be bowel prep followed by a colonoscopy. Urgent colonoscopy within 24 hours is recommended for severe hematochezia.<br /><br />The document discusses different techniques for polypectomy, such as cold biopsy, cold snare, hot snare, and hot biopsy. It emphasizes the importance of proper equipment, preparation, and technique for successful polypectomy.<br /><br />Complications of polypectomy include bleeding, perforation, retroperitoneal abscess, and subcutaneous emphysema. Post-polypectomy hemorrhage can be treated with endoscopic methods, angiography, or surgery. Post-polypectomy coagulation syndrome, which is caused by local peritoneal irritation, may require supportive management and surgical consultation if symptoms persist.<br /><br />The document also covers colonic decompression indications and techniques. It suggests using as little air as possible during decompression and using CO2 for insufflation if available. It discusses the use of decompression tubes as an adjunct to endoscopic decompression for unprepared colon cases.<br /><br />Overall, the document emphasizes the importance of proper management and techniques in therapeutic colonoscopy, including the evaluation and treatment of lower GI bleeding and the safe and effective perforation and polyp removal.

Keywords

therapeutic colonoscopy

lower gastrointestinal bleeding

polypectomy complications

acute lower GI bleeding

diverticular bleeding

ischemic colitis

angioectasia

hemorrhoids

colorectal neoplasia

postpolypectomy bleeding