Colonoscopy Without Bowel Preparation for Acute Lower GI Bleeding

Colonoscopy Without Bowel Preparation for Acute Lower GI Bleeding

Douglas K. Rex, MD, MASGE, reviewing Mizuki A, et al. Endosc Int Open 2022 Jan 14.

Colonoscopy for acute lower GI bleeding is usually performed after bowel purge. In a retrospective study with clinical diverticular bleeding, 266 patients received bowel preparation (prepared group) and 60 underwent colonoscopy without preparation (unprepared group). Stigmata of recent hemorrhage (SRH) was described as an actively bleeding vessel, a nonbleeding visible vessel, or an adherent clot. 

The unprepared group had a higher number of cases of active bleeding and transfusion volume. Cecal intubation was achieved in 80% of the unprepared group. SRH was found in 45% of the unprepared group versus 26% of the prepared group. The mean time to starting colonoscopy after admission was 7.5 hours in the unprepared group versus 18.7 hours in the prepared group. SRH was found most often when the patient underwent colonoscopy within 3 hours; the rate of SRH identification with a colonoscopy in the first 12 hours was 42.3% versus 20.9% after 12 hours (P<.001).

Douglas K. Rex, MD, FASGE


Urgent colonoscopy for acute lower GI bleeding does not clearly improve patient outcomes. Nevertheless, earlier colonoscopy may be more likely to enable gastroenterologists to make a specific diagnosis. Many patients with acute lower GI bleeding now undergo CT angiography; therefore, when an angiography shows active bleeding, these data and some other studies suggest consideration can be given in select cases to proceeding immediately to colonoscopy without bowel preparation.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Mizuki A, Tatemichi M, Nakazawa A, Tsukada N, Nagata H, Kanai T. Identification of diverticular bleeding needs early colonoscopy rather than preparation. Endosc Int Open 2022;10:E50-E55. (

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