First Year Fellows Endoscopy Course (July 31 - August 1)

8-Therapeutic_Colonoscopy

Pdf Summary

This document covers various topics related to therapeutic colonoscopy, including the management of lower gastrointestinal (GI) bleeding, polypectomy techniques and complications, and colonoscopic decompression. Lower GI bleeding is defined as bleeding from a source distal to the IC valve that lasts less than three days and may result in hemodynamic instability or the need for blood transfusion. Etiologies of lower GI bleeding include diverticular bleeding, ischemic colitis, angioectasia, hemorrhoids, colorectal neoplasia, and more.<br /><br />In the case of a 75-year-old female presenting with painless bright red blood per rectum, the best next step in management would be a bowel prep followed by colonoscopy. Colonoscopy is considered the test of choice for acute lower GI bleeding because it allows for precise localization, possible therapy, and has a low complication rate.<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. Polypectomy techniques discussed include cold biopsy, cold snare, hot snare/electrocautery, hot biopsy, and endoscopic mucosal resection (EMR).<br /><br />Other topics covered in the document include the non-endoscopic management of acute lower GI bleeding, treatment options for diverticular bleeding and vascular lesions like angioectasias, and tips for polypectomy and post-polypectomy complications.<br /><br />The document also highlights the importance of knowing one's limits and not starting a procedure if unable to finish, as well as the use of tattooing to demarcate lesions that may require future localization.<br /><br />In conclusion, this document provides an overview of various aspects of therapeutic colonoscopy and offers guidelines for the management of acute lower GI bleeding, polypectomy, and colonoscopic decompression.

Keywords

therapeutic colonoscopy

lower gastrointestinal bleeding

polypectomy techniques

complications

colonoscopic decompression

bowel prep

acute lower GI bleeding

injection therapy

thermal therapy

mechanical therapy