Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding, Based on Propensity Score Matching Analysis.
Clin Gastroenterol Hepatol. 2015 Oct 19;
Authors: Nagata N, Niikura R, Sakurai T, Shimbo T, Aoki T, Moriyasu S, Sekine K, Okubo H, Imbe K, Watanabe K, Yokoi C, Yanase M, Akiyama J, Uemura N
BACKGROUND & AIMS: We investigated the safety and effectiveness of early colonoscopy (performed within 24 hrs of hospital admission) for acute lower gastrointestinal bleeding (LGIB) vs elective colonoscopy (performed 24 h after admission).
METHODS: We conducted a retrospective study using a database of endoscopies performed at the National Center for Global Health and Medicine, in Tokyo, Japan from January 2009 through December 2014. We analyzed data from 538 patients emergently hospitalized for acute LGIB. We used propensity score matching to adjust for differences between patients who underwent early colonoscopy vs elective colonoscopy. Outcomes included rates of adverse events during bowel preparation and colonoscopy procedures, stigmata of recent hemorrhage, endoscopic therapy, blood transfusion requirement, 30 day re-bleeding and mortality, and length of hospital stay.
RESULTS: We selected 163 pairs of patients for analysis, based on propensity matching. We observed no significant differences between the early and elective colonoscopy groups in bowel preparation-related rates of adverse events (1.8% vs 1.2%, P=.652), colonoscopy-related rates of adverse event rates (none in either group), blood transfusion requirement (27.6% vs 27.6%, P=1.000), or mortality (1.2% vs 0, P=.156). The early colonoscopy group had higher rates than the elective group for stigmata of recent hemorrhage (26.4% vs 9.2%, P<.001) and endoscopic therapy (25.8% vs 8.6%, P<.001), including clipping (17.8% vs 4.9%, P < 0.001), band ligation (6.1% vs 1.8%, P=1.000), and re-bleeding (13.5% vs 7.4%, P=.070). Patients in the early colonoscopy group stayed in the hospital for a shorter mean time (10 days) than patients in the elective colonoscopy group (13 days) (P<.001).
CONCLUSIONS: Early colonoscopy for patients with acute LGIB is safe, allows for endoscopic therapy because it identifies the bleeding source, and reduces hospital stay. However, compared to elective colonoscopy, early colonoscopy does not reduce mortality and may increase the risk for rebleeding.
PMID: 26492844 [PubMed - as supplied by publisher]