EFFECTIVENESS OF CURRENT TECHNOLOGY IN THE DIAGNOSIS AND MANAGEMENT OF LOWER GASTROINTESTINAL HEMORRHAGE

Lower gastrointestinal hemorrhage is a common clinical problem for whi ch multiple diagnostic tests and therapeutic interventions have been d eveloped but no optimal approach has been established. We reviewed 107 consecutive patients admitted to the Massachusetts General Hospital f or management of acute lower gastrointestinal hemorrhage to determine the effectiveness of diagnostic and management technologies, with part icular attention to urgent colonoscopy. Colonoscopy yielded a diagnosi s in 90% of patients, provided the opportunity for successful therapy in 9 of 13 patients (69%), and shortened hospital stay. Angiography pe rformed after a scan positive for bleeding was often diagnostic, and a ngiography provided the means for successful therapy in 5 of 10 patien ts (50%). Barium enema and sigmoidoscopy had lower clinical yields. Al though roles exist for other technologies, colonoscopy is the most con venient and effective first test in the evaluation of patients with si gnificant lower gastrointestinal hemorrhage. Diagnostic yield, therape utic opportunity, and cost effectiveness are maximized in early studie s.