Does Urgent Colonoscopy Improve Outcomes in the Management of Lower Gastrointestinal Bleeding?

Seth, Ankur; Khan, Muhammad Ali; Nollan, Richard; Gupta, Divyansh; Kamal, Sehrish; Singh, Utkarsh; Kamal, Faisal; Howden, Colin W.

doi:10.1016/j.amjms.2016.11.007

Cited by 31 publications

(27 citation statements)

References 24 publications

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“…However, this finding has not been translated into any reduction in rates of mortality or rebleeding. 49 The same findings were published in a meta-analysis by Roshan Afshar et al Nevertheless, they found early colonoscopy was associated with increased detection of definitive sources of bleeding, shorter length of stay, and low complication incidence. 50 Currently, no risk stratification score is validated to assess whether patients with LGIB benefit from an urgent colonoscopy.…”

Section: Lower Gastrointestinal Bleedingsupporting

confidence: 57%

Endoscopic Management of Gastrointestinal Bleeding

2018

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Background Gastrointestinal bleeding (GIB) represents a significant cause of morbidity and mortality. The primary diagnostic and therapeutic tool is endoscopy. New devices are being developed and employed that facilitate the management of this pathology. In this review, we show the status of endoscopic management of digestive hemorrhage, current practices, and future directions. Methods We explore the management of patients with GIB (upper and lower). Besides, we analyzed the diagnostic methods in occult digestive hemorrhage. We show the evidence collected so far, and how each therapeutic method can be applied. Results GIB constitutes a challenge for the attending physician. Different therapeutic procedures are available. Less invasive devices have a role in the diagnosis but not therapy. The use of risk stratification is well established for upper bleeding, but for lower bleeding, there is still no evidence to support the use of these scores. Knowledge of altered anatomy is crucial in special populations. Conclusion A variety of procedures are available for the treatment of GIB. Emphasis should be placed on less invasive diagnostic techniques as well as on new and more efficient therapies. Attention should be given to the initial management, with timely diagnosis and effective resuscitation to decrease the morbidity and mortality.

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Section: Lower Gastrointestinal Bleedingsupporting

confidence: 57%

Endoscopic Management of Gastrointestinal Bleeding

2018

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“…Previous studies of outcomes in urgent colonoscopy versus elective colonoscopy have shown conflicting results. Three meta‐analyses have been reported in patients with acute LGI bleeding, comparing urgent colonoscopy with elective colonoscopy . In two of the meta‐analyses, urgent colonoscopy yielded a significantly higher rate of SRH detection as compared to selective colonoscopy, and no significant differences in rebleeding rate, hospital mortality rate, or conversion rate to surgery.…”

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

confidence: 99%

“…Three meta‐analyses have been reported in patients with acute LGI bleeding, comparing urgent colonoscopy with elective colonoscopy . In two of the meta‐analyses, urgent colonoscopy yielded a significantly higher rate of SRH detection as compared to selective colonoscopy, and no significant differences in rebleeding rate, hospital mortality rate, or conversion rate to surgery. However, the other meta‐analysis including six more cohort studies showed different results, whereby the endoscopic treatment rate was significantly higher in urgent colonoscopy cases, but there was no significant difference in the rates of SRH detection, rebleeding, transfusion, or mortality.…”

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

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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

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“…ly phase and those who waited some interval before undergoing colonoscopy [71][72][73]. Two of these 3 studies included 2 randomized controlled studies [35,36], 4 observational studies, and 1 retrospective cohort study that involved propensity score matching [74] and the results revealed a significantly higher rate of identifying the source of bleeding in the early colonoscopy group, with no significant difference in rebleeding rate, in-hospital mortality, or rate of transition to surgery [71,72]. In contrast, the third study that included 2 randomized controlled studies and 10 observational studies found that the rate of performing endoscopic therapy was significantly higher in the early colonoscopy group, with no significant difference in the rate of identifying the source of bleeding, unexpected complications, rebleeding, blood transfusion, or death [73].…”

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

confidence: 99%

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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Does Urgent Colonoscopy Improve Outcomes in the Management of Lower Gastrointestinal Bleeding?

Cited by 31 publications

References 24 publications

Endoscopic Management of Gastrointestinal Bleeding

Endoscopic Management of Gastrointestinal Bleeding

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

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

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