Comparison of clinical effectiveness of the emergent colonoscopy in patients with hematochezia according to the type of bowel preparation

Lim, Dae Seop; Kim, Hyun Gun; Jeon, Seong Ran; Shim, Kwang Yeun; Lee, Tae Hee; Kim, Jin–Oh; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong

doi:10.1111/jgh.12264

Cited by 11 publications

(14 citation statements)

References 22 publications

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“…The frequencies of unexpected adverse events attributable to oral lavage agents do not differ significantly between acute LGIB and non-GI bleeding [75], and bowel preparation has been shown to facilitate the accurate diagnosis of disease and SRH (see CQ13) and enable endoscopic treatment [62]. On the other hand, the rate of reaching the cecum was not high, in the range of 20-70%, among patients who had colonoscopy in the early phase without bowel preparation with oral lavage solution [76][77][78][79], and 6.4% of the patients (22/345) developed fever after colonoscopy [79]. Two retrospective observational studies have investigated the difference in cecal intubation rates between bowel preparation with oral lavage solutions and other bowel preparation methods (e.g., enema) [76,78] and reported a higher rate with the former [76,78].…”

Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

“…In a study conducted by Niikura et al [22], the identification of SRH was improved by colonoscopy (i) when performed within 24 h, (ii) by expert endoscopists who have performed > 1,000 colonoscopies, and (iii) with the use of disposable distal attachments and water-jet systems. Although the primary treatment outcome was not to improve the identification rate of SRH in the studies, other studies have also reported that bowel preparation with oral lavage solutions and colonoscopy performed within 24 h improve the identification rate of SRH [35,71,74,76,83]. Statement: There are several endoscopic hemostatic methods including epinephrine injection, coagulation, clipping, and ligation (EBL and detachable snare ligation), among which ligation is less frequently associated with transition to arterial embolization and surgery, suggesting that it is more effective than the other methods.…”

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

“…On the other hand, the rate of reaching the cecum was not high, in the range of 20-70%, among patients who had colonoscopy in the early phase without bowel preparation with oral lavage solution [76][77][78][79], and 6.4% of the patients (22/345) developed fever after colonoscopy [79]. Two retrospective observational studies have investigated the difference in cecal intubation rates between bowel preparation with oral lavage solutions and other bowel preparation methods (e.g., enema) [76,78] and reported a higher rate with the former [76,78]. Use of other bowel preparation methods (without using oral lavage solutions) is acceptable and bowel preparation itself can be eliminated in patients with post-polypectomy bleeding or rectal ulcer in which bleeding sources can be anticipated before colonoscopy.…”

Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

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Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

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Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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“…There is limited evidence comparing bowel preparation regimens. A retrospective review comparing polyethylene glycol solution with glycerine or water enemas in patients undergoing colonoscopy for LGIB found higher diagnostic yields and reduced need for repeat colonoscopy in the polyethylene glycol group 40. A retrospective review of complications in patients receiving bowel preparation in LGIB reported that the most common complications were hypotension and vomiting, although no patient experienced aspiration pneumonia and volume overload 28…”

Section: Diagnosismentioning

confidence: 99%

“…However, blood is a potent laxative and if the bleeding point is known to be in the distal colorectum, for example, post-polypectomy bleed or source identified in CTA, an enema and copious washing may suffice (although the use of an enema alone is described by a small, retrospective, proof of concept study) 40. CO 2 with gas exchange should be used to reduce gas explosion risk in poorly prepared colons, and diathermy or argon plasma coagulation use should be carefully considered.…”

Section: Therapymentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

244

241

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Is bowel preparation necessary for early colonoscopy in patients with suspected colonic diverticular bleeding?: A multicenter retrospective study with propensity score matching analysis

Gonai,

Toya,

Kudara

et al. 2023

DEN Open

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ObjectivesThere are few reports on bowel preparation for early colonoscopy in patients with suspected colonic diverticular bleeding (CDB). We aim to clarify in a retrospective, multicenter study.MethodsIn a multicenter retrospective cohort study at 10 institutions, we analyzed clinical features of patients diagnosed with CDB, who underwent early colonoscopy within 24 h. We compared patients who were prepared with polyethylene glycol lavage (PEL) and those without PEL. We evaluated the effects of PEL for early colonoscopy in patients with suspected CDB.ResultsA total of 129 (53%) underwent under preparation with PEL and 113 patients without PEL. The PEL group was younger, had fewer comorbidities, and had better performance status. After adjusting for these variables with propensity score matching, the PEL group had a significantly shorter hospital stay (7.9 ± 4.7 vs. 10.1 ± 5.2 days; p = 0.001), and a higher cecal intubation rate (91.1% vs. 50.0%; p < 0.001). There were no significant differences in adverse event rates, identification of stigmata of recent hemorrhage, or frequency in endoscopic hemostatic treatment.ConclusionsPEL may be preferred for early colonoscopy in patients suspected of having CDB.

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Comparison of clinical effectiveness of the emergent colonoscopy in patients with hematochezia according to the type of bowel preparation

Abstract: In hematochezia patients, the PEG group showed a higher diagnostic rate and lower rate of repeated CFS. However, emergent CFS after an enema only seems to be useful in patients with severe hematochezia or if the bleeding focus can be presumed.

Cited by 11 publications

References 22 publications

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Is bowel preparation necessary for early colonoscopy in patients with suspected colonic diverticular bleeding?: A multicenter retrospective study with propensity score matching analysis

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