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

Humans Retrospective Studies Colonoscopy / methods Gastrointestinal Hemorrhage / diagnosis Acute Disease Odds Ratio

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
01 2023
Historique:
received: 30 04 2022
revised: 08 07 2022
accepted: 22 07 2022
pubmed: 6 8 2022
medline: 20 12 2022
entrez: 5 8 2022
Statut: ppublish

Résumé

We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower GI bleeding. We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6270 patients who underwent a colonoscopy within 120 hours were included in this study. The inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 hours, n = 4133), elective (24-48 hours, n = 1137), and late (48-120 hours, n = 1000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding rate. The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR) or surgery requirement and 30-day mortality did not significantly differ among groups. The interaction with heterogeneity of effects was observed between early and late colonoscopy and shock index (shock index <1, odds ratio [OR], 2.097; shock index ≥1, OR, 1.095; P for interaction = .038) and performance status (0-2, OR, 2.481; ≥3, OR, .458; P for interaction = .022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR or surgery requirement in the shock index ≥1 cohort (OR, .267; 95% confidence interval, .099-.721) compared with late colonoscopy. Early colonoscopy increased the rate of SRH identification and shortened the length of stay but involved an increased risk of rebleeding and did not improve mortality and IVR or surgery requirement. Early colonoscopy particularly benefited patients with a shock index ≥1 or performance status ≥3 at presentation.

Sections du résumé

BACKGROUND AND AIMS
We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower GI bleeding.
METHODS
We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6270 patients who underwent a colonoscopy within 120 hours were included in this study. The inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 hours, n = 4133), elective (24-48 hours, n = 1137), and late (48-120 hours, n = 1000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding rate.
RESULTS
The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR) or surgery requirement and 30-day mortality did not significantly differ among groups. The interaction with heterogeneity of effects was observed between early and late colonoscopy and shock index (shock index <1, odds ratio [OR], 2.097; shock index ≥1, OR, 1.095; P for interaction = .038) and performance status (0-2, OR, 2.481; ≥3, OR, .458; P for interaction = .022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR or surgery requirement in the shock index ≥1 cohort (OR, .267; 95% confidence interval, .099-.721) compared with late colonoscopy.
CONCLUSIONS
Early colonoscopy increased the rate of SRH identification and shortened the length of stay but involved an increased risk of rebleeding and did not improve mortality and IVR or surgery requirement. Early colonoscopy particularly benefited patients with a shock index ≥1 or performance status ≥3 at presentation.

Identifiants

DOI: 10.1016/j.gie.2022.07.025 PMID: 35931139
pubmed: 35931139
pii: S0016-5107(22)01863-6
doi: 10.1016/j.gie.2022.07.025
pii:
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

89-99.e10

Informations de copyright

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Yasutoshi Shiratori (Y)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Naoki Ishii (N)

Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan. Electronic address: naoishi0328@gmail.com.

Tomonori Aoki (T)

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Katsumasa Kobayashi (K)

Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.

Atsushi Yamauchi (A)

Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.

Atsuo Yamada (A)

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Jun Omori (J)

Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.

Taiki Aoyama (T)

Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.

Naoyuki Tominaga (N)

Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan.

Yoshinori Sato (Y)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.

Takaaki Kishino (T)

Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.

Tsunaki Sawada (T)

Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.

Masaki Murata (M)

Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Akinari Takao (A)

Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.

Kazuhiro Mizukami (K)

Department of Gastroenterology, Oita University, Oita, Japan.

Ken Kinjo (K)

Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.

Shunji Fujimori (S)

Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.

Takahiro Uotani (T)

Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.

Minoru Fujita (M)

Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.

Hiroki Sato (H)

Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

Sho Suzuki (S)

Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan.

Toshiaki Narasaka (T)

Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan; Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan.

Junnosuke Hayasaka (J)

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.

Tomohiro Funabiki (T)

Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan; Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.

Yuzuru Kinjo (Y)

Department of Gastroenterology, Naha City Hospital, Okinawa, Japan.

Akira Mizuki (A)

Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.

Shu Kiyotoki (S)

Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan.

Tatsuya Mikami (T)

Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan.

Ryosuke Gushima (R)

Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

Hiroyuki Fujii (H)

Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.

Yuta Fuyuno (Y)

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Naohiko Gunji (N)

Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan.

Yosuke Toya (Y)

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.

Kazuyuki Narimatsu (K)

Department of Internal Medicine, National Defense Medical College, Saitama, Japan.

Noriaki Manabe (N)

Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan.

Koji Nagaike (K)

Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan.

Tetsu Kinjo (T)

Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan.

Yorinobu Sumida (Y)

Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

Sadahiro Funakoshi (S)

Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan.

Kiyonori Kobayashi (K)

Department of Gastroenterology, Kitasato University, School of Medicine, Kanagawa, Japan.

Tamotsu Matsuhashi (T)

Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan.

Yuga Komaki (Y)

Digestive and Lifestyle Diseases, and Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

Kuniko Miki (K)

Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.

Kazuhiro Watanabe (K)

Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.

Kazuki Yamamoto (K)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Takaaki Yoshimoto (T)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Ayaka Takasu (A)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Takashi Ikeya (T)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Fumio Omata (F)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Katsuyuki Fukuda (K)

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.

Mitsuru Kaise (M)

Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.

Naoyoshi Nagata (N)

Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: nnagata_ncgm@yahoo.co.jp.

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