Endoscopic Treatment for Repeated Arterial Bleeding with Ulcerative Colitis

Excerpt

Bloody diarrhea is a cardinal symptom of patients with moderate to severe ulcerative colitis (UC). In a recent study, acute massive lower gastrointestinal (GI) bleeding represented only 0.1% of admissions for ulcerative colitis [1]. Other reported incidence rates vary from 1.4% to 4.2% [2‐4]. In a recent overview of emergencies in UC patients, approximately 6%–10% of all urgent colectomies performed were due to hemorrhage [5]. In the setting of UC, bleeding from inflamed mucosa is most often diffuse, and arterial bleeding is only observed in a small subset of patients. Emergency proctocolectomy is advocated as the only reliable treatment for this patient group and is also the treatment of choice in cases of toxic megacolon and perforation. However, urgent colectomy is associated with high morbidity and mortality in the setting of hemodynamic instability and active bleeding [6]. When a discrete source of bleeding can be identified, endoscopic treatment may provide a new modality for the treatment of massive lower GI bleeding in the setting of UC. …