Outcomes of Early Versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database

Nigam, Neha; Patel, Parita; Sengupta, Neil

doi:10.1097/mcg.0000000000000937

Cited by 15 publications

(17 citation statements)

References 14 publications

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“…This slight reduction in length of stay also was observed in prior studies examining the role of early colonoscopy in patients with acute LGIB. 11,12 These findings also were observed in a larger cross-sectional study using the Nationwide Inpatient Sample database. 13 Although the early colonoscopy group underwent fewer endoscopic interventions, it is plausible that this allowed identification of select low-risk patients in whom the initial diverticular bleed had resolved spontaneously and, thus, facilitated earlier discharge.…”

Section: Discussionsupporting

confidence: 62%

“…This decreased intervention rate is different from the aforementioned studies, 11 as well as results from our previously published work. 12 There are a few potential explanations for this finding. First, the lack of interventions in early colonoscopy may be representative of real-world management of diverticular bleeding because our data set is a national representative sample.…”

Section: Discussionmentioning

confidence: 99%

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Early Colonoscopy for Diverticular Bleeding Does Not Reduce Risk of Postdischarge Recurrent Bleeding: A Propensity Score Matching Analysis

Nigam

Ham

Sengupta

2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Colonoscopy within 24 hours (early colonoscopy) is recommended for patients with colonic diverticular bleeding, but it is unclear if this strategy improves postdischarge outcomes. We aimed to determine whether early colonoscopy is associated with decreased risk of rebleeding and hospital re-admission within 30 days. METHODS: We performed a retrospective cohort study using Marketscan (Truven Health Analytics, Inc, Ann Arbor, MI), a nationwide insurance claims database. From January 2004 through September 2015, patients with a primary diagnosis of diverticular bleeding who underwent inpatient colonoscopy were included. We used propensity score matching to account for differences between recipients of early vs delayed colonoscopy. Multivariable logistic regression was performed to determine the association between early colonoscopy and rebleeding or hospital re-admission within 30 days of discharge. RESULTS: In total, 20,010 patients underwent colonoscopy for diverticular bleeding; 11,690 underwent early colonoscopy. After propensity matching, 8320 pairs of patients were analyzed. In the matched analysis, higher proportions of patients who received early colonoscopy underwent additional colonoscopies (73%), compared with patients who did not receive early colonoscopy (4%) (P < .0001), but lower proportions received endoscopic interventions (3% vs 8%; P < .0001). On multivariable analysis, early colonoscopy (odds ratio [OR], 1.34; 95% CI, 1.08-1.66; P [ .007), transfusion requirement (OR, 2.31; 95% CI, 1.88-2.83; P < .0001), and baseline chronic kidney disease (OR, 2.13; 95% CI, 1.49-3.04; P < .0001) were associated with increased risk of rebleeding within 30 days.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Early Colonoscopy for Diverticular Bleeding Does Not Reduce Risk of Postdischarge Recurrent Bleeding: A Propensity Score Matching Analysis

Nigam

Ham

Sengupta

2019

Clinical Gastroenterology and Hepatology

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“…Another RCT did not show any difference in clinical outcome with EC and it was prematurely terminated [10]. Similarly, observational studies [20,21] showed that EC provided no mortality benefit. Results from seven meta-analyses [28][29][30][31][32][33][34] have yielded mixed results, with four reporting no difference in diagnostic yield [28,30,32,34] while three report increased diagnostic yield [29,31,33]; all showed no difference in rebleeding rate; all reported no difference in LOS except one [29]; no difference in transfusion requirement but one reported increased transfusion for EC [33]; all showed no difference in mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…We report here that between 2005 and 2014, the number of patients admitted with LGIB has increased, but mortality among these patients is improving. In addition, despite guidelines and non-randomized data supporting that EC may lead to more rapid identification of colonic lesions 11 and shorter hospital LOS 15 20 21 22 23 , EC has not been widely adopted. Finally, in patients admitted with LGIB, EC was associated with decreased LOS and cost of hospitalization, but no significant difference in mortality compared to LC.…”

Section: Discussionmentioning

confidence: 99%

Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding

et al. 2021

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Background and study aims Current guidelines conditionally recommend performing early colonoscopy (EC) (< 24 hours) in patients admitted with acute lower gastrointestinal bleeding (LGIB). It remains unclear whether this practice is implemented widely. Therefore, we used the Nationwide Inpatient Sample to investigate trends for timing of colonoscopy in patients admitted with acute LGIB. We also assessed trend of hospitalization and mortality in patients with LGIB. Patients and methods Adult patients with LGIB admitted from 2005 to 2014 were examined. ICD-9-CM codes were used to extract LGIB discharges. Trends were assessed using Cochrane-Armitage test. Factors associated with mortality, cost of hospitalization, and length of stay (LOS) were assessed by multivariable mixed-effects and exact-matched logistic, linear regression, and accelerated-failure time models, respectively. Results A total of 814,647 patients with LGIB were included. The most common etiology of LGIB was diverticular bleeding (49 %) and 45 % of patients underwent EC. Over the study period, there was no change in the trend of colonoscopy timing. Although admission with LGIB increased over the study period, the mortality rate decreased for patients undergoing colonoscopy. Independent predictors of mortality were age, surgery (colostomy/colectomy) during admission, intensive care unit admission, acute kidney injury, and blood transfusion requirement. Timing of colonoscopy was not associated with mortality benefit. However, cost of hospitalization was $ 1,946 lower and LOS was 1.6 days shorter with EC. Conclusion Trends in colonoscopy timing in management of LGIB have not changed over the years. EC is associated with lower LOS and cost of hospitalization but it does not appear to improve inpatient mortality.

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“…[23][24][25] Similarly, in acute lower GI bleeding, early colonoscopy compared with elective one does not benefit in terms of rebleeding, hospital stay, and mortality. [26][27][28] In patient with acute cholangitis with varying severity, most of the patients respond to aggressive hydration and IV antibiotics, and 20-30% of patients with severe cholangitis require biliary drainage. 29 ERCP is the best method for biliary drainage in patients with acute cholangitis, and emergent ERCP within 48 hours reduces mortality, hospital stay and organ failures.…”

Section: Triaging Before Endoscopymentioning

confidence: 99%

Indications for Gastrointestinal Endoscopy during the COVID-19 Pandemic

Gunjan

Garg

2020

Journal of Digestive Endoscopy

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The global pandemic due to COVID-19 presents an unprecedented challenge to mankind including healthcare providers. Many COVID-19 infected patients may present with gastrointestinal symptoms. Endoscopic services may be required in complicated COVID-19 infected or suspected patients. In addition, resource allocation would demand judicious use of endoscopy services. There is a definite risk of transmission of COVID-19 during endoscopy to healthcare professionals. We recommend that only emergency and life-saving endoscopic procedures should be performed during COVID-19 pandemic, and semi-elective procedures should be performed after careful consideration. All routine endoscopy procedures should be deferred till normal hospital services resume. For emergency endoscopy procedures, prescreening of patients is critical to avoid nosocomial transmission. To prevent cross-infection among healthcare professionals, strict infection control measures should be practiced in endoscopy suite while providing essential endoscopic services to the patients.

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Outcomes of Early Versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database

Abstract: Early colonoscopy does not affect 30-day mortality but may allow for earlier endoscopic intervention and decreased transfusion need.

Cited by 15 publications

References 14 publications

Early Colonoscopy for Diverticular Bleeding Does Not Reduce Risk of Postdischarge Recurrent Bleeding: A Propensity Score Matching Analysis

Early Colonoscopy for Diverticular Bleeding Does Not Reduce Risk of Postdischarge Recurrent Bleeding: A Propensity Score Matching Analysis

Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding

Indications for Gastrointestinal Endoscopy during the COVID-19 Pandemic

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