Colonic diverticular bleeding and predictors of the length of hospitalization: An observational study

Wada, Mitsuru; Nishizawa, Toshihiro; Kato, Motohiko; Hirai, Yukio; Kinoshita, Satoshi; Mori, Hideki; Nakazato, Yoshihiro; Fujimoto, Ai; Kikuchi, Masahiro; Uraoka, Toshio; Kanai, Takanori

doi:10.1111/jgh.14603

Cited by 10 publications

(19 citation statements)

References 42 publications

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“…Our study revealed a shorter length of hospitalization in the urgent colonoscopy group, which was consistent with the findings of previous reports 7,19,21 . This may only reflect that urgent colonoscopy allows physicians to recognize patients' condition and decide on the therapeutic strategy, which contributes to an earlier discharge from hospital.…”

Section: Discussionsupporting

confidence: 92%

“…According to previous studies, the efficacy of urgent colonoscopy for CDB was controversial. One retrospective study reported that urgent colonoscopy shortened the length of admission for CDB 7 . Similar randomized control trial studies, which targeted LGB rather than CDB, reported inconsistent results regarding the efficacy of urgent colonoscopy in terms of the length of hospital stay, blood transfusion, re‐bleeding, and surgery 9–11 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the efficacy of urgent endoscopy for LGB, particularly CDB, is controversial. One single‐center retrospective observational study reported that urgent colonoscopy for CDB could shorten the length of hospitalization 7 . However, several randomized control trials have reported controversial results regarding the efficacy of urgent colonoscopy for LGB 8–11 .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score‐matched analysis using a nationwide database in Japan

Moroi

Tarasawa

Shiga

et al. 2020

J of Gastro and Hepatol

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Background and Aim Although colonic diverticular bleeding (CDB) is considered to have good prognosis with conservative therapy, some cases are severe. The efficacy of urgent colonoscopy for CDB and clinical factors affecting CDB prognosis are unclear. This study aimed to evaluate the efficacy of urgent colonoscopy for CDB and identify risk factors for unfavorable events, including in‐hospital death during admission, owing to CDB. Methods We collected CDB patients' data using the Diagnosis Procedure Combination database system. We divided eligible patients into urgent and elective colonoscopy groups using propensity score matching and compared endoscopic hemostasis and in‐hospital death rates and length of hospital stay. We also conducted logistic regression analysis to identify clinical factors affecting CBD clinical events, including in‐hospital death, a relatively rare CDB complication. Results Urgent colonoscopy reduced the in‐hospital death rate (0.35% vs 0.58%, P = 0.033) and increased the endoscopic hemostasis rate (3.0% vs 1.7%, P < 0.0001) compared with elective colonoscopy. Length of hospitalization was shorter in the urgent than in the elective colonoscopy group (8 vs 9 days, P < 0.0001). Multivariate analysis also revealed that urgent colonoscopy reduced in‐hospital death (odds ratio = 0.67, 95% confidence interval: 0.46–0.97, P = 0.036) and increased endoscopic hemostasis (odds ratio = 1.84, 95% confidence interval: 1.53–2.22, P < 0.0001). Conclusion Urgent colonoscopy for CDB may facilitate identification of the bleeding site and reduce in‐hospital death. The necessity and appropriate timing of urgent colonoscopy should be considered based on patients' condition.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score‐matched analysis using a nationwide database in Japan

Moroi

Tarasawa

Shiga

et al. 2020

J of Gastro and Hepatol

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“…Available evidence comparing early vs. elective colonoscopy in the management of patients with acute LGIB consists of seven systematic reviews with meta-analyses [55][56][57][58][59][60][61], four RCTs [51,[62][63][64], and 16 observational studies [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] (Table 7 s). Patients with "minor" LGIB managed as outpatients and patients with an UGIB source were excluded from the RCTs [51,[62][63][64] and most of the observational studies [66,67,69,[71][72][73][74][75][76][77][78].…”

Section: What Is the Appropriate Timing For Colonoscopy In Patients With Acute Lower Gastrointestinal Bleeding?mentioning

confidence: 99%

“…We considered the certainty of evidence to be low, despite the significant number of studies evaluating the appropriate timing of colonoscopy. All but one [80] of the observational studies were retrospective [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79], and the definitions and selection criteria were heterogeneous. All RCTs were nonblinded, with some concerns regarding bias (Tables 7 s and 8 s), and two trials were terminated before reaching the pre-planned sample size [51,63].…”

Section: Recommendationmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends that the initial assessment of patients presenting with acute lower gastrointestinal bleeding should include: a history of co-morbidities and medications that promote bleeding; hemodynamic parameters; physical examination (including digital rectal examination); and laboratory markers. A risk score can be used to aid, but should not replace, clinician judgment.Strong recommendation, low quality evidence. 2 ESGE recommends that, in patients presenting with a self-limited bleed and no adverse clinical features, an Oakland score of ≤ 8 points can be used to guide the clinician decision to discharge the patient for outpatient investigation.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and no history of cardiovascular disease, a restrictive red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 7 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of 7–9 g/dL is desirable.Strong recommendation, low quality evidence. 4 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and a history of acute or chronic cardiovascular disease, a more liberal red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 8 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of ≥ 10 g/dL is desirable.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients with major acute lower gastrointestinal bleeding, colonoscopy should be performed sometime during their hospital stay because there is no high quality evidence that early colonoscopy influences patient outcomes.Strong recommendation, low quality of evidence. 6 ESGE recommends that patients with hemodynamic instability and suspected ongoing bleeding undergo computed tomography angiography before endoscopic or radiologic treatment to locate the site of bleeding.Strong recommendation, low quality evidence. 7 ESGE recommends withholding vitamin K antagonists in patients with major lower gastrointestinal bleeding and correcting their coagulopathy according to the severity of bleeding and their thrombotic risk. In patients with hemodynamic instability, we recommend administering intravenous vitamin K and four-factor prothrombin complex concentrate (PCC), or fresh frozen plasma if PCC is not available.Strong recommendation, low quality evidence. 8 ESGE recommends temporarily withholding direct oral anticoagulants at presentation in patients with major lower gastrointestinal bleeding.Strong recommendation, low quality evidence. 9 ESGE does not recommend withholding aspirin in patients taking low dose aspirin for secondary cardiovascular prevention. If withheld, low dose aspirin should be resumed, preferably within 5 days or even earlier if hemostasis is achieved or there is no further evidence of bleeding.Strong recommendation, moderate quality evidence. 10 ESGE does not recommend routinely discontinuing dual antiplatelet therapy (low dose aspirin and a P2Y12 receptor antagonist) before cardiology consultation. Continuation of the aspirin is recommended, whereas the P2Y12 receptor antagonist can be continued or temporarily interrupted according to the severity of bleeding and the ischemic risk. If interrupted, the P2Y12 receptor antagonist should be restarted within 5 days, if still indicated.Strong recommendation, low quality evidence.

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Obscure Gastrointestinal Bleeding Due to Colonic Source

Klapheke

Bortniker

2020

Curr Treat Options Gastro

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Colonic diverticular bleeding and predictors of the length of hospitalization: An observational study

Cited by 10 publications

References 42 publications

Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score‐matched analysis using a nationwide database in Japan

Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score‐matched analysis using a nationwide database in Japan

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Obscure Gastrointestinal Bleeding Due to Colonic Source

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