LAUSR

Ileocolonoscopy (IC) is the usual procedure in cases of acute lower GI bleeding (LGIB). It should be performed within 8 to 24 hours of a patient’s presentation after adequate colon cleansing to improve its diagnostic and therapeutic yield, which can range from 48% to 90%. According to American guidelines, 4 to 6 liters of polyethylene glycol (PEG)-based iso-osmolar solution should be rapidly administered over 3 to 4 hours until rectal effluent is clear; also, a nasogastric tube is used to facilitate the instillation in high-risk patients. However, the high volume delays the procedure, and it is poorly acceptable to patients. Recently, a very-low-volume hyperosmolar bowel preparation, based on a combination of ascorbate with 1 L PEG (PEG-Asc), has been validated in randomized trials, showing superiority compared with 2 L PEG-Asc, trisulfate, and sodium picosulfate with magnesium citrate. We report the case of a 70-year-old man with a history of chronic atrial fibrillation who had been receiving ongoing anticoagulant therapy. He was hospitalized for hemorrhagic shock and severe anemia, secondary to massive LGIB. Initial resuscitation with fluids and blood transfusions was performed. Once the patient’s condition was hemodynamically stable, a nasogastric tube (to avoid the adverse event of aspiration of stomach contents in a patient with compromised mental status) was used to instill the novel 1-L PEGþAsc solution (Plenvu; Norgine, The Netherlands)