ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding

This is one of a series of statements discussing The utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text in preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear Clinical consideration may justify a course of action at variance to these recommendations. Lower-GI bleeding (LGIB) ranges from trivial to massive, life-threatening blood loss. LGIB accounts for an estimated 20% of all major GI bleeds. 1,2 The annual incidence of LGIB requiring hospitalization is approximately 21 cases per 100,000 adults in the United States.(3) It is predominantly a disease of the elderly, with a greater than 200-fold increase from the second to the eighth decade of life.(3) The mean age of patients ranges from 63 to 77 years. (4) Although the majority of patients have a self-limited illness and an uncomplicated hospitalization, the reported mortality rate ranges from 2% to 4%.(4) This guideline represents an updated review of LGIB and its management.(5 6)