Acute and chronic management of lower gastrointestinal bleeding: cost-effective approaches.

This article is concerned with current diagnosis and treatment of patients with severe lower gastrointestinal (GI) bleeding. Our purposes were to discuss tests available for diagnosis and treatment and to present our approach and to discuss cost assessment of different approaches. We evaluated 100 consecutive patients who presented with severe and persistent lower GI bleeding. Patients were continually monitored and had polyethylene sulfate purge to cleanse the colon. Panendoscopy revealed an upper GI source in 11%. Presumed small bowel bleeding accounted for 9%, and no site was found in 6%. During emergency colonoscopy at the bedside, a definite colonic lesion was found in 74% of patients. Angiomata accounted for 30% of total or 41% of all colonic bleeding sites. Diverticula were the source of bleeding in 23%, ulcerated colonic polyps or cancers in 15% of colonic sites, focal colitis or ulceration in 12%, rectal lesions in 5%, and other colonic sources in 4%. Based on 1990 data and costs of services to the patients with severe ongoing hematochezia, we estimated that by using emergency colonoscopy rather than medical, angiographic, and surgical management, a mean of $10,065 per patient was saved.