Is Urgent Diagnostic Colonoscopy still Necessary in Lower Gastrointestinal Bleeding?: A Retrospective Study from 2 Centers of Ramathibodi Hospital

Abstract

Background: An urgent colonoscopy within 24 hours in acute lower gastrointestinal bleeding (LGIB) is now controversy with limited of benefit compare to elective colonoscopy. An alternative modality such as CT angiogram or CT whole abdominal has play an important role in diagnosed and localised bleeding site in emergency setting. Objective: This study is aim to report a descriptive data of incidence and prevalence of acute LGIB and therapeutic modality from 2 centers of Ramathibodi Hospital. Materials and Methods: A retrospective reviewed of adult patients who had acute LGIB in 4 years of Acute Care Surgery service of Ramathibodi Hospital and one year service of Chakri Naruebodindra Medical Institute. An exclusion criteria were patients who had associated gastrointestinal perforation or dead on arrival. A descriptive data were analysed and reported. Results: A 127 patients were enrolled, an average age is 69 year-old. Of these, there are 74.01% admitted without hemorrhagic shock. An average hospital stay is 3 days (1 to 5). Anti-coagulant and anti-platelet usage are 40.16%. Average haemoglobin on admission is 9.69±2.43 g/dL. Overall mortality rate is 4.72%. Most common cause of acute LGIB are diverticular bleeding 34.65% and colitis 17.32%. Only 9.82% underwent urgent colonoscopy. There are 95.28%, 1.57%, 0.79%, and 1.57% of successful nonoperative management, therapeutic endoscopy, transarterial catheter embolization and surgery, respectively. Only patients who had post-polypectomy bleeding underwent urgent therapeutic endoscopy intervention. Conclusion: In hemodynamic stable, urgent colonoscopy is not mandate in routine. In acute massive LGIB which hemodynamic unstable, the CT angiography follow by arterial embolisation or urgent colonoscopy are recommend for diagnosed, localised the bleeding site, and also endoscopic intervention especially in post-procedure bleeding. Keywords: Lower gastrointestinal bleeding; Urgent colonoscope; CT angiogram; Abdominal CT scan