Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study,Gastrointestinal Endoscopy

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Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2022-08-02 , DOI: 10.1016/j.gie.2022.07.025
Yasutoshi Shiratori ₁ , Naoki Ishii ₂ , Tomonori Aoki ₃ , Katsumasa Kobayashi ₄ , Atsushi Yamauchi ₅ , Atsuo Yamada ₃ , Jun Omori ₆ , Taiki Aoyama ₇ , Naoyuki Tominaga ₈ , Yoshinori Sato ₉ , Takaaki Kishino ₁₀ , Tsunaki Sawada ₁₁ , Masaki Murata ₁₂ , Akinari Takao ₁₃ , Kazuhiro Mizukami ₁₄ , Ken Kinjo ₁₅ , Shunji Fujimori ₁₆ , Takahiro Uotani ₁₇ , Minoru Fujita ₁₈ , Hiroki Sato ₁₉ , Sho Suzuki ₂₀ , Toshiaki Narasaka ₂₁ , Junnosuke Hayasaka ₂₂ , Tomohiro Funabiki ₂₃ , Yuzuru Kinjo ₂₄ , Akira Mizuki ₂₅ , Shu Kiyotoki ₂₆ , Tatsuya Mikami ₂₇ , Ryosuke Gushima ₂₈ , Hiroyuki Fujii ₂₉ , Yuta Fuyuno ₃₀ , Naohiko Gunji ₃₁ , Yosuke Toya ₃₂ , Kazuyuki Narimatsu ₃₃ , Noriaki Manabe ₃₄ , Koji Nagaike ₃₅ , Tetsu Kinjo ₃₆ , Yorinobu Sumida ₃₇ , Sadahiro Funakoshi ₃₈ , Kiyonori Kobayashi ₃₉ , Tamotsu Matsuhashi ₄₀ , Yuga Komaki ₄₁ , Kuniko Miki ₄₂ , Kazuhiro Watanabe ₄₃ , Kazuki Yamamoto ₁ , Takaaki Yoshimoto ₁ , Ayaka Takasu ₁ , Takashi Ikeya ₁ , Fumio Omata ₁ , Katsuyuki Fukuda ₁ , Mitsuru Kaise ₆ , Naoyoshi Nagata ₄₄

Affiliation

Department of Gastroenterology, St Luke's International University, Tokyo, Japan.
Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Department of Gastroenterology, Oita University, Oita, Japan.
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan.
Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan; Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan.
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan; Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
Department of Gastroenterology, Naha City Hospital, Okinawa, Japan.
Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan.
Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan.
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan.
Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan.
Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan.
Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan.
Department of Gastroenterology, Kitasato University, School of Medicine, Kanagawa, Japan.
Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan.
Digestive and Lifestyle Diseases, and Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.

Background and Aims

We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower GI bleeding.

Methods

We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6270 patients who underwent a colonoscopy within 120 hours were included in this study. The inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 hours, n = 4133), elective (24-48 hours, n = 1137), and late (48-120 hours, n = 1000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding rate.

Results

The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR) or surgery requirement and 30-day mortality did not significantly differ among groups. The interaction with heterogeneity of effects was observed between early and late colonoscopy and shock index (shock index <1, odds ratio [OR], 2.097; shock index ≥1, OR, 1.095; P for interaction = .038) and performance status (0-2, OR, 2.481; ≥3, OR, .458; P for interaction = .022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR or surgery requirement in the shock index ≥1 cohort (OR, .267; 95% confidence interval, .099-.721) compared with late colonoscopy.

Conclusions

Early colonoscopy increased the rate of SRH identification and shortened the length of stay but involved an increased risk of rebleeding and did not improve mortality and IVR or surgery requirement. Early colonoscopy particularly benefited patients with a shock index ≥1 or performance status ≥3 at presentation.

中文翻译：

急性下消化道出血结肠镜检查的时机：一项多中心回顾性队列研究

背景和目标

我们的目的是确定结肠镜检查的最佳时机以及对因急性下消化道出血而接受早期结肠镜检查的患者有益的因素。

方法

我们确定了在日本 49 家医院收治的 10,342 名急性便血患者（CODE BLUE-J 研究）。其中，6270 名在 120 小时内接受结肠镜检查的患者被纳入本研究。治疗加权法的逆概率用于调整早期（≤24 小时，n = 4133）、选择性（24-48 小时，n = 1137）和晚期（48-120 小时，n = 1000）的基线特征结肠镜检查。评估结果的平均治疗效果。主要结果是 30 天再出血率。

结果

与选择性和晚期组相比，早期组的近期出血 (SRH) 识别的柱头率明显更高，住院时间更短。然而，早期组的 30 天再出血率明显高于择期组和晚期组。介入放射学 (IVR) 或手术要求和 30 天死亡率在各组之间没有显着差异。在早期和晚期结肠镜检查与休克指数（休克指数 <1，优势比 [OR]，2.097；休克指数 ≥1，OR，1.095；交互作用P = .038）和体能状态（ 0-2，或，2.481；≥3，或，.458；P相互作用 = .022) 30 天再出血。与晚期结肠镜检查相比，早期结肠镜检查在休克指数≥1 队列中的 IVR 或手术要求显着降低（OR，0.267；95% 置信区间，0.099-0.721）。