Acute lower gastrointestinal bleeding: SPECIFIC CAUSES OF LGI BLEEDING Part 5
Endoscopic therapy, once reserved for high risk patients, is now considered to be standard practice for these lesions. Once the lesion has been identified, endoscopic therapy may involve heater probe, bipolar and monopolar electrode, argon plasma coagulation and laser. Several studies evaluating endoscopic electrocoagulation have found success rates ranging from 70% to 80%. The largest series evaluated was from the Center for Ulcer Research and Education (CURE) Hemostasis Research Group, which enrolled 100 patients with bleeding from colonic angiomata in a long term prospective study over two years. The mean number of colonoscopic treatments was 1.4 (range one to four), with endoscopic coagulation (bipolar or heater probe) performed on 716 colonic angiomas (mean seven per session, range one to 48). When comparing endoscopic treatment with medical treatment (the two years before endoscopic diagnosis), significant decreases were seen in the number of LGI bleeding episodes per year (1.3/year compared with 0.6/year) and number of units of red blood cell transfusions (4.3/year compared with 1.3/year). Similarly, there was significant improvement in hematocrit, which rose from 26.8% before colonoscopic therapy to 37.3% after therapy. During long term follow-up, 18% of patients required surgical intervention (usually a right hemicolectomy); 39% of these patients continued to have recurrent bleeding after their surgeries. Interestingly, this included four patients with renal failure and one who was taking anticoagulants for cardiac valvular disease. Earlier studies on angiodysplastic lesions did not demonstrate such a high recurrent bleeding rate postoperatively, although some patients did have coagulation defects. Very cheap drugs at your disposal – generic viagra online pharmacy to get best deals at best pharmacy.