Early colonoscopy does not improve outcomes in lower-GI bleeding

By Anne Harding

NEW YORK (Reuters Health) - 3/10/2019

Routine early colonoscopy in patients with acute lower-gastrointestinal bleeding (ALGIB) appears to be of little use compared with elective colonoscopy, according to new findings.

"We demonstrated that colonoscopy within 24 hrs after hospital admission did not increase stigmata-of-recent-hemorrhage identification or reduce rebleeding compared with colonoscopy after 24 hrs in patients with acute lower-gastrointestinal bleeding," Dr. Atsu Yamada of the University of Tokyo in Japan told Reuters Health by email.

Early colonoscopy - performed within eight to 24 hours of hospital admission for severe bleeding - is recommended for diagnosis and treatment of patients with ALGIB, Dr. Yamada and colleagues note in in Gastroenterology, online September 26.

"Controversy remains as to whether early colonoscopy improves important outcomes including rebleeding, need for transfusion and mortality," they add.

To investigate, the authors allocated 170 patients with ALGIB at 15 hospitals in Japan to early colonoscopy, within 24 hours of first hospital visit; or elective colonoscopy, performed 24 to 96 hours after admission.

SRH was identified in 21.5% of the early colonoscopy group and 21.3% of the elective colonoscopy patients (P=0.967). Rebleeding within 30 days of admission occurred in 15.3% and 6.7%, respectively, which also was not a statistically significant difference.

Rates of successful endoscopic treatment, transfusion rates, thrombotic events, 30-day mortality and hospital length of stay were similar for the two groups.

None of the patients in the early-colonoscopy group developed hemorrhagic shock during bowel preparation, compared to two in the delayed colonoscopy group.

The authors caution that the study was not blinded and that the findings cannot be generalized to patients who develop ALGIB in the hospital or those with severe ALGIB and hemorrhagic shock refractory to blood transfusion, because such patients were not included in the study.

SOURCE: https://bit.ly/2ptz6Hl

Gastroenterology 2019.

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