title: Utility of urgent colonoscopy in acute lower gastro-intestinal bleeding: a single-center experience.
abstract: BACKGROUND
  The role of urgent colonoscopy in lower gastro-intestinal bleeding (LGIB) remains controversial. Over the last two decades, a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions; however, studies comparing this approach to elective colonoscopy for LGIB are limited.
  
  
  OBJECTIVE
  To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit (ICU) with acute LGIB.
  
  
  METHODS
  Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively. Patients were grouped into urgent vs. elective colonoscopy, depending on the timing of colonoscopy after admission to the ICU. Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective. Outcomes included length of hospital stay, early re-bleeding rates, and the need for additional diagnostic or therapeutic interventions. Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements.
  
  
  RESULTS
  Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB, 24 of which were urgent. There was no significant difference in patient demographics, co-morbidities, or medications between the two groups. Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability (P = 0.019) and require blood transfusions (P = 0.003). No significant differences in length of hospital stay, re-bleeding rates, or the need for additional diagnostic or therapeutic interventions were found. Patients requiring blood transfusions (n = 27) were more likely to be female (P = 0.016) and diabetics (P = 0.015). Fourteen patients re-bled at a median of 2 days after index colonoscopy. Those with hemodynamic instability were more likely to re-bleed [HR 3.8 (CI 1.06-13.7)], undergo angiography [HR 9.8 (CI 1.8-54.1)], require surgery [HR 13.5 (CI 3.2-56.5)], and had an increased length of hospital stay [HR 1.1 (1.05-1.2)].
  
  
  CONCLUSIONS
  The use of urgent colonoscopy, as an initial approach to investigate acute LGIB, did not result in significant differences in length of ICU stay, re-bleeding rates, the need for additional diagnostic or therapeutic interventions, or 30-day mortality compared with elective colonoscopy. In a pre-specified subgroup analysis, patients with hemodynamic instability were more likely to re-bleed after index colonoscopy, to require additional interventions (angiography or surgery) and had increased length of hospital stay.
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA albeldm@ccf.org.
authors: Mazen
authors: M
authors: Albeldawi
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Duc
authors: D
authors: Ha
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Paresh
authors: P
authors: Mehta
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Rocio
authors: R
authors: Lopez
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Sunguk
authors: S
authors: Jang
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Madhusudhan R
authors: MR
authors: Sanaka
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: John J
authors: JJ
authors: Vargo
keywords: acute lower gastro-intestinal bleeding; elective colonoscopy; outcomes; urgent colonoscopy