Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding on the Basis of Propensity Score Matching Analysis.
OBJECTIVE
We investigated the safety and effectiveness of early colonoscopy (performed within 24 hours of hospital admission) for acute lower gastrointestinal bleeding (LGIB) vs elective colonoscopy (performed 24 hours after admission).


METHODS
We conducted a retrospective study by 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 rebleeding and mortality, and length of hospital stay.


RESULTS
We selected 163 pairs of patients for analysis on the basis of 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 events (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 < .001), band ligation (6.1% vs 1.8%, P = .048), and rebleeding (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 with elective colonoscopy, early colonoscopy does not reduce mortality and may increase the risk for rebleeding.
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: nnagata_ncgm@yahoo.co.jp.
Naoyoshi
N
Nagata
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Ryota
R
Niikura
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Toshiyuki
T
Sakurai
Clinical Research and Informatics, Ohta Nishinouchi Hospital, Koriyama, Japan.
Takuro
T
Shimbo
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Tomonori
T
Aoki
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Shiori
S
Moriyasu
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Katsunori
K
Sekine
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Hidetaka
H
Okubo
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Koh
K
Imbe
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Kazuhiro
K
Watanabe
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Chizu
C
Yokoi
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Mikio
M
Yanase
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Junichi
J
Akiyama
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.
Naomi
N
Uemura
D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
Colonoscopy Timing; Comparative Analysis; Diverticular Bleeding; Lower Gastrointestinal Hemorrhage; Urgent Colonoscopy