Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding

Ryota Niikura, Naoyoshi Nagata, Atsuo Yamada, Tetsuro Honda, Kenkei Hasatani, Naoki Ishii, Yasutoshi Shiratori, Hisashi Doyama, Tsutomu Nishida, Tetsuya Sumiyoshi, Tomoki Fujita, Shu Kiyotoki, Tomoyuki Yada, Katsumi Yamamoto, Tomohiro Shinozaki, Munenori Takata, Tatsuya Mikami, Katsuhiro Mabe, Kazuo Hara, Mitsuhiro FujishiroKazuhiko Koike

Research output: Contribution to journalArticle

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Abstract

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, Numbers: UMIN000021129 and NCT03098173

Original languageEnglish
Pages (from-to)168-175.e6
JournalGastroenterology
Volume158
Issue number1
DOIs
Publication statusPublished - Jan 2020

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Colonoscopy
Hemorrhage
Safety
Christianity
Length of Stay
Confidence Intervals
Hemorrhagic Shock
Japan
Randomized Controlled Trials

Keywords

  • Acute Lower Gastrointestinal Bleeding
  • Early Colonoscopy
  • Randomized Controlled Trial
  • Stigmata of Recent Hemorrhage

Cite this

Niikura, R., Nagata, N., Yamada, A., Honda, T., Hasatani, K., Ishii, N., ... Koike, K. (2020). Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding. Gastroenterology, 158(1), 168-175.e6. https://doi.org/10.1053/j.gastro.2019.09.010
Niikura, Ryota ; Nagata, Naoyoshi ; Yamada, Atsuo ; Honda, Tetsuro ; Hasatani, Kenkei ; Ishii, Naoki ; Shiratori, Yasutoshi ; Doyama, Hisashi ; Nishida, Tsutomu ; Sumiyoshi, Tetsuya ; Fujita, Tomoki ; Kiyotoki, Shu ; Yada, Tomoyuki ; Yamamoto, Katsumi ; Shinozaki, Tomohiro ; Takata, Munenori ; Mikami, Tatsuya ; Mabe, Katsuhiro ; Hara, Kazuo ; Fujishiro, Mitsuhiro ; Koike, Kazuhiko. / Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding. In: Gastroenterology. 2020 ; Vol. 158, No. 1. pp. 168-175.e6.
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Niikura, R, Nagata, N, Yamada, A, Honda, T, Hasatani, K, Ishii, N, Shiratori, Y, Doyama, H, Nishida, T, Sumiyoshi, T, Fujita, T, Kiyotoki, S, Yada, T, Yamamoto, K, Shinozaki, T, Takata, M, Mikami, T, Mabe, K, Hara, K, Fujishiro, M & Koike, K 2020, 'Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding', Gastroenterology, vol. 158, no. 1, pp. 168-175.e6. https://doi.org/10.1053/j.gastro.2019.09.010

Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding. / Niikura, Ryota; Nagata, Naoyoshi; Yamada, Atsuo; Honda, Tetsuro; Hasatani, Kenkei; Ishii, Naoki; Shiratori, Yasutoshi; Doyama, Hisashi; Nishida, Tsutomu; Sumiyoshi, Tetsuya; Fujita, Tomoki; Kiyotoki, Shu; Yada, Tomoyuki; Yamamoto, Katsumi; Shinozaki, Tomohiro; Takata, Munenori; Mikami, Tatsuya; Mabe, Katsuhiro; Hara, Kazuo; Fujishiro, Mitsuhiro; Koike, Kazuhiko.

In: Gastroenterology, Vol. 158, No. 1, 01.2020, p. 168-175.e6.

Research output: Contribution to journalArticle

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

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, Numbers: UMIN000021129 and NCT03098173

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, Numbers: UMIN000021129 and NCT03098173

KW - Acute Lower Gastrointestinal Bleeding

KW - Early Colonoscopy

KW - Randomized Controlled Trial

KW - Stigmata of Recent Hemorrhage

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