![]() ![]() In critically ill patients, upper endoscopy is indicated first followed by colonoscopy after excluding the upper GI tract as the source of bleeding. In hemodynamically stable patients, urgent (within 8-24 h) colonoscopy is recommended. In case of severe hematochezia, hemodynamic stability determines the diagnostic and therapeutic approach. ![]() Overall, colonoscopy has been reported to have a higher yield than other modalities such as proctosigmoidoscopy, single-contrast barium studies, or combined flexible sigmoidoscopy and double-contrast barium enema for diagnosis of lower GI bleeding. On the other hand, colonoscopy is the recommended procedure for patients with intermittent hematochezia who have one of the following risk factors: age >50, family history of colon cancer, or other alarming symptoms such as weight loss, anemia, and change in bowel habits. However, colonoscopy may still be required if a definitive source cannot be identified. Intermittent scant hematochezia can be diagnosed by anoscopy with/without sigmoidoscopy for low-lying lesions in the anus, rectum, and sigmoid in patients who are younger than 40. If the upper GI endoscopy does not reveal a source of bleeding, colonoscopy is then indicated to identify any colonic source. In patients presenting with melena, upper GI endoscopy is performed first to identify any upper GI causes. Patients who are not good candidates for colonoscopy can be evaluated using CT colonography. Patients with occult GI bleeding require colonoscopy to exclude malignant or adenomatous etiologies. Lower GI bleeding from any cause requires colonoscopy either urgently or routinely. Lower GI bleeding may occur in the form of occult bleeding, melena, scant intermittent hematochezia, or severe hematochezia. In this chapter, we aim to outline the common indications and contraindications for performing colonoscopy and detail the evidence supporting the facts.ΔΆ.1. Therefore, several societies including the American Society of Gastrointestinal Endoscopy (ASGE) and the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), have established guidelines for appropriate use of colonoscopy. Performing colonoscopy for inappropriate indications not only exposes patients to procedure-related complications such as bowel perforation, bleeding, infection, and cardiovascular events, but also increases on the health-care-related cost. A key quality measure of colonoscopy is the indication for the procedure, because as high as 20-50% of colonoscopies are performed for inappropriate indications. The decision to perform colonoscopy should take into account the indication and contraindication for the procedure, the risks of the procedure, and the cost. Since its inception, colonoscopy has become a very popular method for screening of colorectal cancers and for treating a variety of conditions of the lower gastrointestinal tract. William Wolff and Hiromi Shinya developed a way to probe the full length of the colon using a tube with electronic sensors. ![]()
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