Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding.
OBJECTIVE
To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding.


METHODS
A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan.


METHODS
Fifty-five people undergoing bedside colonoscopy for lower GI bleeding that developed while in the ICU.


METHODS
Bedside colonoscopy.


RESULTS
Colonoscopy was successful in diagnosing the source of bleeding in 37 patients. Among them, colitis (15 patients, including ischemic, pseudomembranous, or radiation-induced) and acute hemorrhagic rectal ulcer (nine patients) were the most frequent confirmed causes. In seven patients, fresh blood was noticed above the colonoscopically accessible area and considered to originate from the small bowel. No adverse event was associated with colonoscopy. Spontaneous cessation of bleeding was noted in 29 (29/55, 53%) patients, whereas 16 (16/55, 29%) achieved endoscopic hemostasis. Ten (10/55, 18%) patients failed primary hemostasis or localization. Overall in-hospital mortality was 53% (29/55); however, hemorrhage-related death occurred in only two patients.


CONCLUSIONS
ICU patients with acute lower GI bleeding have distinctive causes. Bedside colonoscopy is effective for diagnosis in two-thirds of patients, but only a minority of them needs endoscopic hemostasis.
Lin
Chun-Che
CC
Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien Kuo N. Rd., 402 Taichung, Taiwan.
Lee
Yi-Chia
YC
Lee
Huei
H
Lin
Jaw-Town
JT
Ho
Wei-Chi
WC
Chen
Tan-Hsia
TH
Wang
Hsiu-Po
HP
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D016896:Treatment Outcome