American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in acute lower gastrointestinal bleeding.

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides evidence-based recommendations regarding the role of endoscopy in the diagnosis and management of acute lower GI bleeding (LGIB). This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. In the broad context of acute LGIB, this guideline addresses the use of colonoscopy versus CT +/- angiography as the first modality, urgent versus nonurgent colonoscopy, and prepped versus unprepped colonoscopy. For diverticular bleeding in particular, this guideline assesses endoscopic band ligation versus clipping and direct clipping of the bleeding site or vessel versus indirect clip closure of the diverticulum. All of these clinical questions were answered using the GRADE framework. The guideline also discusses the roles of upper endoscopy and surgery in the setting of acute LGIB and outlines the absolute and relative contraindications of colonoscopy. Finally, the guideline provides an overview of available endoscopic modalities to treat LGIB, with special attention to the evidence supporting the use of specific modalities according to lesion type. A summary of recommendations is provided in Table 1.