Management of gastrointestinal bleeding induced by gastrointestinal endoscopy

Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonsc opic polypectomy has a risk of approximately 1.6% of inducing bleeding, com pared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher -risk procedures include colonoscopic polypectomy, endoscopic biliary sphin cterotomy, endoscopic dilatation, endoscopic variceal therapy, percutaneous endoscopic gastrostomy, and endoscopic sharp foreign body retrieval. The r isk of inducing hemorrhage is decreased by meticulous endoscopic technique. Hemorrhage from endoscopy may be immediate or delayed. Immediate hemorrhag e should be immediately treated by endoscopic hemostatic therapy, including injection therapy, thermocoagulation, or electrocoagulation. Delayed hemor rhage generally requires repeat endoscopy for diagnosis and for therapy, us ing the same hemostatic techniques.