TY - JOUR
T1 - Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding
AU - Niikura, Ryota
AU - Nagata, Naoyoshi
AU - Yamada, Atsuo
AU - Honda, Tetsuro
AU - Hasatani, Kenkei
AU - Ishii, Naoki
AU - Shiratori, Yasutoshi
AU - Doyama, Hisashi
AU - Nishida, Tsutomu
AU - Sumiyoshi, Tetsuya
AU - Fujita, Tomoki
AU - Kiyotoki, Shu
AU - Yada, Tomoyuki
AU - Yamamoto, Katsumi
AU - Shinozaki, Tomohiro
AU - Takata, Munenori
AU - Mikami, Tatsuya
AU - Mabe, Katsuhiro
AU - Hara, Kazuo
AU - Fujishiro, Mitsuhiro
AU - Koike, Kazuhiko
N1 - Funding Information:
Funding The authors received a grant from the Japanese Gastroenterological Association Foundation. Conflicts of interest This author discloses the following: Mitsuhiro Fujishiro has received lecture honoraria from Takeda Pharmaceutical, AstraZeneca, Zeria, and Daiichi-Sankyo; research grants for unrestricted purposes from Takeda Pharmaceutical and EA Pharma; and collaborative funding from HOYA-Pentax. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2020 AGA Institute
PY - 2020/1
Y1 - 2020/1
N2 - Background & Aims: We performed a large, multicenter, randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower gastrointestinal bleeding (ALGIB). Methods: We performed an open-label study at 15 hospitals in Japan of 170 patients with ALGIB randomly assigned (1:1) to groups that underwent early colonoscopy (within 24 hours of initial visit to the hospital) or elective colonoscopy (24–96 hours after hospital admission). The primary outcome was identification of stigmata of recent hemorrhage (SRH). Secondary outcomes were rebleeding within 30 days, endoscopic treatment success, need for transfusion, length of stay, thrombotic events within 30 days, death within 30 days, and adverse events. Results: SRH were identified in 17 of 79 patients (21.5%) in the early colonoscopy group vs 17 of 80 patients (21.3%) in the elective colonoscopy group (difference, 0.3; 95% confidence interval, –12.5 to 13.0; P =. 967). Rebleeding within 30 days of hospital admission occurred in 15.3% of patients in the early colonoscopy group and 6.7% of patients in the elective colonoscopy group (difference, 8.6; 95% confidence interval, –1.4 to 18.7); there were no significant differences between groups in successful endoscopic treatment rate, transfusion rate, length of stay, thrombotic events, or death within 30 days. The adverse event of hemorrhagic shock occurred during bowel preparation in no patient in the early group vs 2 patients (2.5%) in the elective colonoscopy group. Conclusions: In a randomized controlled study, we found that colonoscopy within 24 hours after hospital admission did not increase SRH or reduce rebleeding compared with colonoscopy at 24–96 hours in patients with ALGIB. ClinicalTrials.gov,
AB - Background & Aims: We performed a large, multicenter, randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower gastrointestinal bleeding (ALGIB). Methods: We performed an open-label study at 15 hospitals in Japan of 170 patients with ALGIB randomly assigned (1:1) to groups that underwent early colonoscopy (within 24 hours of initial visit to the hospital) or elective colonoscopy (24–96 hours after hospital admission). The primary outcome was identification of stigmata of recent hemorrhage (SRH). Secondary outcomes were rebleeding within 30 days, endoscopic treatment success, need for transfusion, length of stay, thrombotic events within 30 days, death within 30 days, and adverse events. Results: SRH were identified in 17 of 79 patients (21.5%) in the early colonoscopy group vs 17 of 80 patients (21.3%) in the elective colonoscopy group (difference, 0.3; 95% confidence interval, –12.5 to 13.0; P =. 967). Rebleeding within 30 days of hospital admission occurred in 15.3% of patients in the early colonoscopy group and 6.7% of patients in the elective colonoscopy group (difference, 8.6; 95% confidence interval, –1.4 to 18.7); there were no significant differences between groups in successful endoscopic treatment rate, transfusion rate, length of stay, thrombotic events, or death within 30 days. The adverse event of hemorrhagic shock occurred during bowel preparation in no patient in the early group vs 2 patients (2.5%) in the elective colonoscopy group. Conclusions: In a randomized controlled study, we found that colonoscopy within 24 hours after hospital admission did not increase SRH or reduce rebleeding compared with colonoscopy at 24–96 hours in patients with ALGIB. ClinicalTrials.gov,
KW - Acute Lower Gastrointestinal Bleeding
KW - Early Colonoscopy
KW - Randomized Controlled Trial
KW - Stigmata of Recent Hemorrhage
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U2 - 10.1053/j.gastro.2019.09.010
DO - 10.1053/j.gastro.2019.09.010
M3 - Article
C2 - 31563627
AN - SCOPUS:85076161555
VL - 158
SP - 168-175.e6
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 1
ER -