Concerns regarding the recommendations of the British Society of Gastroenterology’s lower GI bleeding guidelines

We are writing with regard to the recently published British Society of Gastroenterology (BSG) lower GI bleeding (LGIB) guidelines.1 We have significant concerns about some of the recommendations. The quick reference flowchart suggests that patients with stable LGIB (shock index <1), classed as having a major (risk scored) bleed, should be admitted for a lower GI endoscopy on the next available list. This is inconsistent with the main body of the guideline which states: a colonoscopy on the next available list. We find this recommendation concerning, particularly as it has implications for endoscopy unit resources, inpatient services, and patient safety. Delivering urgent inpatient colonoscopy in this cohort of patients is logistically challenging. Is a colonoscopy necessary for all? The acute LGIB national audit showed that 73.9% of patients presented with rectal …