12 years after its previous update, @ASGEendoscopy has released its 2026 lower GI bleeding guideline & is now in press in @GIE_Journal. Here's the key shifts from 2014 guidelines: 1. Urgent colonoscopy within 24hrs is NO LONGER emphasized. Colonoscopy is now recommended only for hemodynamically stable patients who can tolerate a full bowel preparation, irrespective of the timing. This matches other national society guidelines where the role of urgent colonoscopy has been already de-emphasized. 2. Hemodynamic instability favors contrast CT/CTA, & the subsequent management is IR-guided. This corresponds to interventional radiology guidelines (SAR) & takes the ball of the acute LGIB to the IR court. This still holds true even in the setting of "modest" acute or chronic kidney disease. "Modest" is undefined. 4. Band ligation is recommended as first line for RIGHT sided diverticulae due to the lower recurrent bleeding. Notably, the risk of perforation with banding is real & the document reports panel disagreement & split opinions regarding this point. The ASGE recommends using a colonoscope ligator & against a gastroscope ligator. Fortunately or unfortunately, colonoscope band ligators are exceedingly rare in the United States, & hence a lower chance of gastroenterologist to debate this point. 5. Clip closure is recommended over band ligation in the LEFT sided diverticulae. In the left colon, clips and bands are equal in efficacy, & in the absence of a clear benefit, taking the perforation risk associated with banding was not worth. 6. Direct clipping of the vessel is suggested over indirect (zipper) closure. This is a new recommendation & is driven by the lower rebleeding rate (nothing to do with diverticulitis). #GITwitter #MedTwitter #MedEd #Endoscopy