Early colonoscopy does not improve lower GI bleeding outcomes
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Moving patients to colonoscopy within 24 hours of hospital admission for acute lower gastrointestinal bleeding does not reduce further bleeding or mortality, according to the results of a meta-analysis published in Clinical Gastroenterology and Hepatology.
Loren Laine, MD, of the section of digestive diseases at Yale School of Medicine, and colleagues wrote that current recommendations suggest that patients undergo early colonoscopy after admission for lower GI bleeding to identify the source of the bleeding.
“Recent meta-analyses of early vs. elective colonoscopy have reported no significant differences in rebleeding or mortality, but some found that early colonoscopy is associated with increased identification of the bleeding source,” they wrote. “However, these meta-analyses include only two small randomized controlled trials both terminated before their planned sample size was reached, and rely primarily on observational studies.”
Laine and colleagues searched the literature for studies that included patients with acute lower GI bleeding or hematochezia and compared early colonoscopy (within 24 hours) with elective colonoscopy (beyond 24 hours). The primary outcome was further bleeding, defined as persistent or recurrent bleeding after index examination.
The investigators identified four randomized trials that fit their criteria. They found that further bleeding was not decreased in patients who underwent early colonoscopy compared with those who underwent elective colonoscopy (RR = 1.57; 95% CI, 0.74–3.31).
Additionally, they found no difference in the secondary outcomes of mortality (RR = 0.93; 95% CI, 0.05–17.21), diagnostic yield (RR = 1.09; 95% CI, 0.99–1.21), endoscopic intervention (RR = 1.53; 95% CI, 0.67–3.48), or any primary hemostatic intervention (RR = 1.33; 95% CI, 0.92–1.92).
“Early colonoscopy within 24 hours does not improve clinical outcomes such as further bleeding or mortality in patients hospitalized with acute LGIB,” Laine and colleagues wrote. “Based on our results we recommend that patients hospitalized with acute LGIB generally need not undergo early colonoscopy.” – by Alex Young
Disclosure: The authors report no relevant financial disclosures.
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