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

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.