Observational Study Indicates Early Colonoscopy, Within 24 Hours of Admission, Benefits Patients With Shock Index ≥1, Performance Status ≥3

Observational Study Indicates Early Colonoscopy, Within 24 Hours of Admission, Benefits Patients With Shock Index ≥1, Performance Status ≥3

Douglas K. Rex, MD, MASGE, reviewing Shiratori Y, et al. Gastrointest Endosc 2022 Aug 2.

Randomized controlled trials of early versus late colonoscopy in acute lower GI bleeding suggest no or limited benefit from early colonoscopy, but some of these trials have excluded certain patients.

In an observational study of 6270 patients undergoing colonoscopy within 120 hours of admission to 49 hospitals in Japan, patients were divided into early (≤24 hours), elective (24-48 hours), and late (48-120 hours) colonoscopy groups. The fraction of patients in each of these groups was 66%, 18%, and 16%, respectively.

For the primary outcome of 30-day rebleeding, and after extensive adjustment for risk factors, 30-day rebleeding was significantly higher in the early colonoscopy group than in the other two groups. There was no difference in interventional radiology (IVR) need, surgery requirement, or 30-day mortality among the groups.

Stigmata of recent hemorrhage were detected more often in the early colonoscopy group, but the length of stay was shorter. Subgroup analysis indicated the group with shock index ≥1 and early colonoscopy had a lower requirement for IVR or surgery (odds ratio, 0.267), and there was a trend toward lower 30-day rebleeding in the early group for patients with performance status ≥3.

Douglas K. Rex, MD, FASGE

COMMENT

The study’s large size and inclusion of all patients undergoing colonoscopy for acute lower GI bleeding merit attention. The associations described here suggest features that could be tested in controlled trials.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Shiratori Y, Ishii N, Aoki T, et al. Timing of colonoscopy in acute lower gastrointestinal bleeding: a multicenter retrospective cohort study. Gastrointest Endosc 2022 Aug 2. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.07.025)

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