American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in acute lower gastrointestinal bleeding
In brief
ASGE guideline recommends colonoscopy as first-line for most acute lower GI bleeds
The new American Society for Gastrointestinal Endoscopy guideline, built with GRADE evidence, advises using colonoscopy rather than CT or angiography as the initial test in acute lower gastrointestinal bleeding, favors urgent over delayed scopes when feasible, and prefers prepped over unprepped exams. It also outlines preferred endoscopic therapies-band ligation or clipping for diverticular bleeding-and lists contraindications, helping clinicians choose the right approach and where evidence gaps remain.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 28 August 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Nauzer Forbes, Nayantara Coelho-Prabhu, Hana Osman, Howard Guo, Sunil Samnani, Indraneel Datta, et al.
- PMID
- 42667281
- DOI
- 10.1016/j.gie.2026.06.046
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 30 August 2026): ASGE guideline on endoscopy for acute lower GI bleeding
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.