Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study

Shiratori, Yasutoshi; Ishii, Naoki; Aoki, Tomonori; Kobayashi, Katsumasa; Yamauchi, Atsushi; Yamada, Atsuo; Omori, Jun; Aoyama, Taiki; Tominaga, Naoyuki; Sato, Yoshinori; Kishino, Takaaki; Sawada, Tsunaki; Murata, Masaki; Takao, Akinari; Mizukami, Kazuhiro; Kinjo, Ken; Fujimori, Shunji; Uotani, Takahiro; Fujita, Minoru; Sato, Hiroki; Suzuki, Sho; Narasaka, Toshiaki; Hayasaka, Junnosuke; Funabiki, Takuzo; Kinjo, Yuzuru; Mizuki, Akira; Kiyotoki, Shu; Mikami, Taisei; Gushima, Ryosuke; Fujii, Hiroyuki; Fuyuno, Yuta; Gunji, Naohiko; Toya, Yosuke; Narimatsu, Kazuyuki; Manabe, Noriaki; Nagaike, Koji; Kinjo, Tetsu; Sumida, Yorinobu; Funakoshi, Sadahiro; Kobayashi, K; Matsuhashi, Tamotsu; Komaki, Yuga; Miki, Kuniko; Watanabe, Kazuhiro; Yamamoto, Kazuki; Yoshimoto, Takaaki; Takasu, Ayaka; Ikeya, Takashi; Fukuda, Katsuyuki; Kaise, Mitsuru; Nagata, Naoyoshi

doi:10.1016/j.gie.2022.07.025

Cited by 13 publications

(15 citation statements)

References 28 publications

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“…In fact, three meta-analyses including randomized controlled trials [38, 42, 43] found that patients did not show any improvement in ALGIB. However, Shiratori et al [44] reported that early colonoscopy was particularly beneficial for patients with a shock index ≥1 or performance status ≥3 at presentation. Therefore, there may be certain populations that may benefit from early colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Weekend Effect on Clinical Outcomes of Acute Lower Gastrointestinal Bleeding: A Large Multicenter Cohort Study in Japan

Hayasaka,

Kikuchi,

Ishii

et al. 2023

Dig Dis

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Introduction: Weekend admissions showed increased mortality in several medical conditions. This study aimed to examine the weekend effect on acute lower gastrointestinal bleeding (ALGIB) and its mortality and other outcomes. Methods: This retrospective cohort study (CODE BLUE-J Study) was conducted at 49 Japanese hospitals between January 2010 and December 2019. In total, 8,120 outpatients with acute hematochezia were enrolled and divided into weekend admissions and weekday admissions groups. Multiple imputation (MI) was used to handle missing values, followed by propensity score matching (PSM) to compare outcomes. The primary outcome was mortality; the secondary outcomes were rebleeding, length of stay (LOS), blood transfusion, thromboembolism, endoscopic treatment, the need for interventional radiology, and the need for surgery. Colonoscopy and computed tomography (CT) management were also evaluated. Results: Before PSM, there was no significant difference in mortality (1.3% vs. 0.9%, p = 0.133) between weekend and weekday admissions. After PSM with MI, 1,976 cases were matched for each admission. Mortality was not significantly different for weekend admissions compared with weekday admissions (odds ratio [OR] 1.437, 95% confidence interval [CI] 0.785–2.630; p = 0.340). No significant difference was found with other secondary outcomes in weekend admissions except for blood transfusion (OR 1.239, 95% CI 1.084–1.417; p = 0.006). Weekend admission had a negative effect on early colonoscopy (OR 0.536, 95% CI 0.471–0.609; p < 0.001). Meanwhile, urgent CT remained significantly higher in weekend admissions (OR 1.466, 95% CI 1.295–1.660; p < 0.001). Conclusion: Weekend admissions decrease early colonoscopy and increase urgent CT but do not affect mortality or other outcomes except transfusion.

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Section: Discussionmentioning

confidence: 99%

Weekend Effect on Clinical Outcomes of Acute Lower Gastrointestinal Bleeding: A Large Multicenter Cohort Study in Japan

Hayasaka,

Kikuchi,

Ishii

et al. 2023

Dig Dis

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“…Endoscopic data were collected, including timing of colonoscopy, stigmata of recent haemorrhage (SRH), diagnosis after first colonoscopy, and method of endoscopic haemostasis. Timing of colonoscopy was divided into early (≤ 24 h), elective (24–48 h), and late (48–120 h) [25]. SRH was defined as active bleeding or a densely adherent clot despite vigorous irrigation or a nonbleeding visible vessel on colonoscopy [26, 27].…”

Section: Methodsmentioning

confidence: 99%

Early feeding reduces length of hospital stay in patients with acute lower gastrointestinal bleeding: A large multicentre cohort study

Kishino,

Aoki,

Sadashima

et al. 2023

Colorectal Disease

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AimNo studies have compared the clinical outcomes of early and delayed feeding in patients with acute lower gastrointestinal bleeding (ALGIB). This study aimed to evaluate the benefits and risks of early feeding in a nationwide cohort of patients with ALGIB in whom haemostasis was achieved.MethodsWe reviewed data for 5910 patients with ALGIB in whom haemostasis was achieved and feeding was resumed within 3 days after colonoscopy at 49 hospitals across Japan (CODE BLUE‐J Study). Patients were divided into an early feeding group (≤1 day, n = 3324) and a delayed feeding group (2–3 days, n = 2586). Clinical outcomes were compared between the groups by propensity matching analysis of 1508 pairs.ResultsThere was no significant difference between the early and delayed feeding groups in the rebleeding rate within 7 days after colonoscopy (9.4% vs. 8.0%; p = 0.196) or in the rebleeding rate within 30 days (11.4% vs. 11.5%; p = 0.909). There was also no significant between‐group difference in the need for interventional radiology or surgery or in mortality. However, the median length of hospital stay after colonoscopy was significantly shorter in the early feeding group (5 vs. 7 days; p < 0.001). These results were unchanged when subgroups of presumptive and definitive colonic diverticular bleeding were compared.ConclusionThe findings of this nationwide study suggest that early feeding after haemostasis can shorten the hospital stay in patients with ALGIB without increasing the risk of rebleeding.

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“…Traditionally, colonoscopy for acute LGIB was recommended to be performed within 24 h of patient presentation [2,30]. Several recent retrospective studies have failed to show any significant differences in mortality, rebleeding and re-hospitalization for early (<24 h) colonoscopy compared with delayed colonoscopy [31 ▪ ,32–34]. Furthermore, systematic reviews of RCTs have shown that colonoscopy performed within that early timeframe has not been shown to improve clinically relevant outcomes when compared with delayed (>24 h) colonoscopy [35,36].…”

Section: Patient Presentationmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding

Elimeleh,

Gralnek

2023

Current Opinion in Gastroenterology

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Purpose of review We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB). Recent findings LGIB primarily presents in the elderly, often on the background of comorbidities, and constitutes a significant healthcare and economic burden worldwide. Therefore, acute LGIB requires rapid evaluation, informed decision-making, and evidence-based management decisions. LGIB management involves withholding and possibly reversing precipitating medications and concurrently addressing risk factors, with definitive diagnosis and therapy for the source of bleeding usually performed by endoscopic or radiological means. Recent advancements in LGIB diagnosis and management, including risk stratification tools and novel endoscopic therapeutic techniques have improved LGIB management and patient outcomes. In recent years, the various society guidelines on acute lower gastrointestinal bleeding have been revised and updated accordingly. Summary By integrating the most recently published high-quality clinical studies and society guidelines, we provide clinicians with an up-to-date and comprehensive overview on acute LGIB diagnosis and management.

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Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study

Cited by 13 publications

References 28 publications

Weekend Effect on Clinical Outcomes of Acute Lower Gastrointestinal Bleeding: A Large Multicenter Cohort Study in Japan

Weekend Effect on Clinical Outcomes of Acute Lower Gastrointestinal Bleeding: A Large Multicenter Cohort Study in Japan

Early feeding reduces length of hospital stay in patients with acute lower gastrointestinal bleeding: A large multicentre cohort study

Diagnosis and management of acute lower gastrointestinal bleeding

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