Endoscopic treatment of lower gastrointestinal bleeding.

Urgent colonoscopy has emerged as the initial diagnostic and main therapeutic tool in the evaluation and treatment of colonic lower gastrointestinal bleeding. Endoscopic therapy can effectively treat most cases of colonic bleeding with a demonstrable improvement in clinical outcome parameters. The identification of high-risk stigmata of hemorrhage enables selective targeting of endoscopic therapy to lesions at high risk of rebleeding. Advances in technologies such as novel mechanical methods of hemostasis (eg, metallic clips), injection techniques (eg, cyanoacrylate injection), and the widening application of established endoscopic hemostatic techniques (eg, rubber-band ligation) to colonic lesions offers the possibility of further improvements in the efficacy of endoscopic hemostasis. Clinical trials are needed to compare these novel endoscopic techniques with more conventional approaches to establish the best form of endoscopic therapy for different bleeding lesions and finally to establish more definitively the optimal timing of colonoscopy.