Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding on the Basis of Propensity Score Matching Analysis
| Autor: | Junichi Akiyama, Ryota Niikura, Takuro Shimbo, Kazuhiro Watanabe, Tomonori Aoki, Shiori Moriyasu, Naomi Uemura, Koh Imbe, Toshiyuki Sakurai, Chizu Yokoi, Mikio Yanase, Hidetaka Okubo, Katsunori Sekine, Naoyoshi Nagata |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Blood transfusion Lower gastrointestinal bleeding Hepatology medicine.diagnostic_test business.industry medicine.medical_treatment Gastroenterology Colonoscopy Retrospective cohort study medicine.disease law.invention Surgery 03 medical and health sciences Acute lower gastrointestinal bleeding 0302 clinical medicine Randomized controlled trial law 030220 oncology & carcinogenesis Propensity score matching medicine 030211 gastroenterology & hepatology Adverse effect business |
| Zdroj: | Clinical Gastroenterology and Hepatology. 14:558-564 |
| ISSN: | 1542-3565 |
| Popis: | Background & Aims 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 P P 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 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|