A multicenter, randomized controlled trial comparing the identification rate of stigmata of recent hemorrhage and rebleeding rate between early and elective colonoscopy in outpatient-onset acute lower gastrointestinal bleeding: study protocol for a randomized controlled trial

Niikura, Ryota; Nagata, Naoyoshi; Yamada, Atsuo; Doyama, Hisashi; Shiratori, Yasutoshi; Nishida, Tsutomu; Kiyotoki, Shu; Yada, Tomoyuki; Fujita, Toshio; Sumiyoshi, Tetsuya; Hasatani, Kenkei; Mikami, Taisei; Honda, Tetsuro; Mabe, Katsuhiro; Hara, Kazuo; Yamamoto, Katsumi; Takeda, Mariko; Takata, Masayuki; Tanaka, Mototsugu; Shinozaki, Tomohiro; Fujishiro, Mitsuhiro; Koike, Kazuhiko

doi:10.1186/s13063-018-2558-y

Cited by 9 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous RCTs were single-center studies and were terminated during enrollment because of difficulties in achieving the originally planned sample size. To address these issues, we are now conducting a multicenter RCT to examine the superiority of early colonoscopy over elective colonoscopy in patients with acute LGIB[46]. The primary outcome measure is identification of SRH.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Initial management for acute lower gastrointestinal bleeding

Aoki

Hirata

Yamada

et al. 2019

WJG

Self Cite

View full text Add to dashboard Cite

Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospital admission. Patients with LGIB often experience persistent or recurrent bleeding and require blood transfusions and interventions, such as colonoscopic, radiological, and surgical treatments. Appropriate decision-making is needed to initially manage acute LGIB, including emergency hospitalization, timing of colonoscopy, and medication use. In this literature review, we summarize the evidence for initial management of acute LGIB. Assessing various clinical factors, including comorbidities, medication use, presenting symptoms, vital signs, and laboratory data is useful for risk stratification of severe LGIB, and for discriminating upper gastrointestinal bleeding. Early timing of colonoscopy had the possibility of improving identification of the bleeding source, and the rate of endoscopic intervention, compared with elective colonoscopy. Contrast-enhanced computed tomography before colonoscopy may help identify stigmata of recent hemorrhage on colonoscopy, particularly in patients who can be examined immediately after the last hematochezia. How to deal with nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents after hemostasis should be carefully considered because of the risk of rebleeding and thromboembolic events. In general, aspirin as primary prophylaxis for cardiovascular events and NSAIDs were suggested to be discontinued after LGIB. Managing acute LGIB based on this information would improve clinical outcomes. Further investigations are needed to distinguish patients with LGIB who require early colonoscopy and hemostatic intervention.

show abstract

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Initial management for acute lower gastrointestinal bleeding

Aoki

Hirata

Yamada

et al. 2019

WJG

Self Cite

View full text Add to dashboard Cite

show abstract

“…Therefore, multiple, large‐scale and prospective RCT are necessary to conclude whether urgent colonoscopy is superior in SRH detection and outcomes after endoscopic hemostasis. In Japan, this type of RCT has been done, and informative results are awaited.…”

Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 99%

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

Kaise

Nagata²,

Ishii

et al. 2019

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrastenhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion. Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 241 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 247 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 249

show abstract

“…This study is a post hoc analysis from a multicenter randomized controlled trial (RCT) of early and elective colonoscopy for ALGIB that investigated the efficacy and safety of the former for patients with ALGIB 3 4 . Briefly, this RCT was an open-label study, and 170 patients aged ≥ 20 years presenting with moderate-to-severe hematochezia or melena within 24 hours of arrival were randomly assigned (1:1) to either receive an early colonoscopy (within 24 hours of the initial visit to the hospital) or an elective colonoscopy (24–96 hours after hospital admission).…”

Section: Methodsmentioning

confidence: 99%

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and study aims It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB. Patients and methods We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality. Results Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % P = 0.0914). Conclusions The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB.

show abstract

A multicenter, randomized controlled trial comparing the identification rate of stigmata of recent hemorrhage and rebleeding rate between early and elective colonoscopy in outpatient-onset acute lower gastrointestinal bleeding: study protocol for a randomized controlled trial

Cited by 9 publications

References 14 publications

Initial management for acute lower gastrointestinal bleeding

Initial management for acute lower gastrointestinal bleeding

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Contact Info

Product

Resources

About