title: Endoscopic hemostasis is rarely used for hematochezia: a population-based study from the Clinical Outcomes Research Initiative National Endoscopic Database.
abstract: BACKGROUND
  Data on the use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings.
  
  
  OBJECTIVE
  To characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who did and did not receive endoscopic hemostasis.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Clinical Outcomes Research Initiative National Endoscopic Database, 2002 to 2008.
  
  
  METHODS
  Adults with hematochezia.
  
  
  METHODS
  None.
  
  
  METHODS
  Demographics, comorbidities, practice setting, adverse events, and colonoscopy procedural characteristics and findings.
  
  
  RESULTS
  We identified 3151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), white (83.3%), and older (mean age 70.9 ± 12.3 years); had a low-risk American Society of Anesthesiologists classification (53.9%); and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be white (83.3% vs 71.0%, P = .02), have more comorbidities (classes 3 and 4, 46.2% vs 36.0%, P = .04), and have the cecum reached (95.8% vs 87.7%, P = .003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of arteriovenous malformations (32.6% vs 2.6%, P = .0001) or a solitary ulcer (8.3% vs 2.1%, P < .0001).
  
  
  CONCLUSIONS
  Retrospective database analysis.
  
  
  CONCLUSIONS
  Less than 5% of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights into in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia.
authors.affiliation: Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Ron-Tal Fisher
authors.affiliation: Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; GI Outcomes Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.affiliation: Oregon Health & Science University, Department of Gastroenterology, Portland, Oregon, USA; The Oregon Clinic, Portland, Oregon, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eisen
authors.affiliation: Oregon Health & Science University, Department of Gastroenterology, Portland, Oregon, USA.
authors.forename: J Luke
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Oregon Health & Science University, Department of Gastroenterology, Portland, Oregon, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Holub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: AE; ASA; AVM; American Society of Anesthesiologists; CORI; Clinical Outcomes Research Initiative; LGIB; NED; National Endoscopic Database; adverse event; arteriovenous malformation; lower GI bleeding