key: cord-0838462-ozcq90lr
authors: Soriani, Paola; Biancheri, Paolo; Hassan, Cesare; Manno, Mauro
title: Updating the recommendations on bowel preparation for acute lower gastro-intestinal bleeding: The time has come!
date: 2021-05-27
journal: Endosc Int Open
DOI: 10.1055/a-1468-4326
sha: 89f7b92c9775006358845d7eeec9b46d51ace96c
doc_id: 838462
cord_uid: ozcq90lr

nan

be updated. We have successfully tested low-volume and verylow-volume PEG-based bowel preparation solutions in high-risk patients with acute LGIB [5] . This approach has the advantage of reducing the cleansing time, which is particularly important in those patients who need to restart antithrombotic therapy as soon as possible.

As an example, during the last 18 months, three patients (all men, mean age 69 years) presented to our unit with acute LGIB and hemorrhagic shock. All three patients were on regular antithrombotic therapy with warfarin, which had been suspended and reversed on patient arrival at the Emergency Department. We administered very-low-volume bowel preparation and performed emergency colonoscopy within 8 hours after arrival at the hospital. In all three patients, we achieved an optimal bowel preparation quality (Boston score 9), which enabled us to identify the bleeding source (1 Dieulafoy lesion at the cecum and 2 oozing vessels near a diverticular orifice, both in the sigmoid). All three bleeding lesions were effectively treated with through-the-scope clips, with complete hemostasis at the end of the procedure. Overall hemodynamic conditions improved rapidly after endoscopic treatment, and this allowed for an early restart of the antithrombotic therapy, which all three patients were taking regularly.

The possibility of achieving good-quality diagnostic and therapeutic colonoscopy in high-risk patients with acute LGIB is of paramount importance, especially in hospitals where interventional radiology is not available. This is even more relevant during the Covid-19 pandemic, when the transfer of patients between hospitals should be restricted to minimize the risk of spreading infection and optimize human and technological resources. Therefore, we suggest that, in the setting of acute LGIB in high-risk patients, the sentence "less is more" should apply to bowel preparation volume.

Systematic review with metaanalysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding

Early colonoscopy does not improve outcomes of patients with lower gastrointestinal bleeding: systematic review of randomized trials

Acute lower gastrointestinal bleeding during the Covid-19 pandemic -less is more! Letter to the Editor

ACG Clinical Guideline: management of patients with acute lower gastrointestinal bleeding

Efficacy of rapid bowel preparation with new 1 L polyethylene glycol ascorbate solution in severe acute lower GI bleeding

The authors declare that they have no conflict of interest.