On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand)

Video Transcription

Video Summary

Dr. Callie Levine reviewed endoscopic management of lower GI bleeding, emphasizing that diverticular hemorrhage is the most common cause, though 10–15% of hematochezia—especially with instability—may come from a brisk upper GI bleed.<br /><br />For unstable patients, CTA can guide early interventional radiology involvement; stable patients may undergo colonoscopy. Colonoscopy has high diagnostic but relatively low therapeutic yield, and urgent colonoscopy within 24 hours has not been shown to improve key outcomes. When diverticular bleeding stigmata are found, treatment options include clips, band ligation, over-the-scope clips, and selected thermal or topical therapies. Direct clipping is preferable to indirect clipping. Band ligation may reduce rebleeding, particularly for right-sided lesions, but carries potential risks; through-the-scope clips are generally favored on the left.<br /><br />For post-polypectomy bleeding, immediate bleeding can be treated with clips or brief soft coagulation. Many patients with delayed bleeding do not need repeat colonoscopy, so clinical factors such as ongoing bleeding, instability, hemoglobin drop, and anticoagulant use can guide triage. Avoid excessive thermal therapy on ulcerated bases.<br /><br />The discussion also highlighted using irrigation and patience to clear blood and clots, considering small-bowel evaluation when blood persists in the terminal ileum, and counseling patients about rebleeding risk.

Asset Subtitle

Calley Levine, MD

Meta Tag

Concept Lower Gastrointestinal Bleeding

Concept Colonic Diverticular Bleeding

Concept Post-Polypectomy Bleeding

Concept Hematochezia

Concept Computed Tomography Angiography

Keywords

lower GI bleeding

diverticular hemorrhage

hematochezia

CTA

colonoscopy

post-polypectomy bleeding

rebleeding risk

endoscopic hemostasis

Lower Gastrointestinal Bleeding

Colonic Diverticular Bleeding

Post-Polypectomy Bleeding

Hematochezia

Computed Tomography Angiography