Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study.
BACKGROUND
Urgent colonoscopy is not always the preferred initial intervention in severe lower GI bleeding because of the need for a large volume of oral bowel preparation, the time required for administering the preparation, and concern regarding adequate visualization.


OBJECTIVE
To evaluate the feasibility, safety, and outcomes of immediate unprepared hydroflush colonoscopy for severe lower GI bleeding.


METHODS
Prospective feasibility study of immediate colonoscopy after tap-water enema without oral bowel preparation, aided by water-jet pumps and mechanical suction devices in patients admitted to the intensive care unit with a primary diagnosis of severe lower GI bleeding.


METHODS
Tertiary referral center.


METHODS
Primary outcome measurement was the percentage of colonoscopies in which the preparation permitted satisfactory evaluation of the entire length of the colon suspected to contain the source of bleeding. Secondary outcome measurements were visualization of a definite source of bleeding, length of hospital and intensive care unit (ICU) stays, rebleeding rates, and transfusion requirements.


RESULTS
Thirteen procedures were performed in 12 patients. Complete colonoscopy to the cecum was performed in 9 of 13 patients (69.2%). However, endoscopic visualization was thought to be adequate for definitive or presumptive identification of the source of bleeding in all procedures, with no colonoscopy repeated because of inadequate preparation. A definite source of bleeding was identified in 5 of 13 procedures (38.5%). The median length of ICU stay was 1.5 days; of hospital stay, 4.3 days. Recurrent bleeding during the same hospitalization, requiring repeated endoscopy, surgery, or angiotherapy, was seen in 3 of 12 patients (25%).


CONCLUSIONS
Uncontrolled feasibility study of selected patients.


CONCLUSIONS
Immediate unprepared hydroflush colonoscopy in patients with severe lower GI bleeding is feasible with the hydroflush technique.
Division of Gastroenterology and Liver Disease, Digestive Health Institute, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio 44106, USA.
Aparna
A
Repaka
Matthew R
MR
Atkinson
Ashley L
AL
Faulx
Gerard A
GA
Isenberg
Gregory S
GS
Cooper
Amitabh
A
Chak
Richard C K
RC
Wong
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000175:diagnosis* / Q000628:therapy; D003113:Colonoscopy / Q000379:methods*; D004733:Enema / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D014867:Water
D014867:Water