Acute Lower Gastrointestinal Bleeding Research Articles

EXPLAINABLE MACHINE LEARNING MODEL FOR PREDICTING GI BLEED MORTALITY IN THE ICU

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Acute upper and lower gastrointestinal (GI) bleed is a common reason for hospitalization with 2-10% risk of mortality. Several scoring systems for mortality prediction in GI bleed have been developed, however, none of these are considered part of the standard of care. In this study we used machine learning to develop a model to calculate the risk of mortality in critically ill patients admitted for GI bleed and compared it to the traditionally used mortality risk assessment score, APACHE IVa. Since one of the limitations for using machine learning models in practical setting has been lack of physician trust in the model, we utilized explainable methods to provide insight into the model's prediction and outcome. METHODS: We analyzed patient data in the eICU Collective Research Database consisting of critically ill patients and extracted data for 5691 patients (mean age = 67.4 years; 61% males) admitted with GI bleed (upper-, lower- and unknown GI bleed). The data was utilized in training a gradient-boosting machine learning model to identify patients who died in the ICU. We compared the predictive performance of the machine learning model with the APACHE IVa score, a widely accepted risk scoring system for critically ill patients. Performance was measured by area under receiver operating characteristic curve (AUC) analysis. This study also utilizes explainable machine learning methods to provide insights into the model’s outcome prediction using the SHAP (SHapley Additive exPlanations) method. RESULTS: The machine learning model performed better than APACHE IVa risk score in correctly classifying patients who are low risk. The ML model had a specificity of 55% (95% CI: 52 – 64) at sensitivity of 100% compared with APACHE score which had a specificity of 4% (95% CI: 3 –43) at sensitivity of 100%. The model identified patients who died with an AUC of 0.90 (95% CI: 0.93 - 0.86) in the internal validation set while the APACHE IVa clinical scoring systems identified patients who died with AUC values of 0.82 (95% CI: 0.88 - 0.76) with p-value <0.001. CONCLUSIONS: We developed a machine learning model that identifies patients with GI bleed who are at risk of dying with a greater accuracy than current risk scoring systems. We also provide insights into why the model is predicting a certain outcome in order to build trust with physician. CLINICAL IMPLICATIONS: We developed a machine learning model that predicts mortality in patients with GI bleed with a greater AUC than that of the current scoring system. This model could help with identification of critically ill GI bleed patients who are at low risk of mortality and can be moved out of the ICU into a step-down unit for monitoring. By making machine learning model explainable, clinicians would be better able to understand the reasoning behind the outcome and thus would be more likely to implement it in clinical practice to make patient-centered decisions. DISCLOSURES: No relevant relationships by Farah Deshmukh, source=Web Response No relevant relationships by Shamel Merchant, source=Web Response

Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding.

To evaluate the clinical effect and safety of cone-beam CT (CBCT)-guided empirical embolization for acute lower gastrointestinal bleeding (LGIB) in patients with a positive CT angiography (CTA) but subsequent negative digital subtraction angiography (DSA). A retrospective study of consecutive LGIB patients with a positive CTA who received a DSA within 24h from January 2008 to July 2019. Patients with a positive DSA were treated with targeted embolization (TE group). Patients with a negative DSA underwent an empiric CBCT-guided embolization of the assumed ruptured vas rectum (EE group) or no embolization (NE group). Recurrent bleeding, major ischemic complications, and in-hospital mortality were compared by means of Fisher's exact test. Further subgroup analysis was performed on hemodynamic instability. Eighty-five patients (67.6years ± 15.7, 52 men) were included (TE group, n = 47; EE group, n = 19; NE group, n= 19). If DSA was positive, technical success of targeted embolization was 100% (47/47). If DSA was negative and the intention to treat by empiric CBCT-guided embolization, technical success was 100% (19/19). Recurrent bleeding rates in the TE group, EE group, and NE group were 17.0% (8/47), 21.1% (4/19), and 52.6% (10/19) respectively. Empiric CBCT-guided embolization reduced rebleeding significantly in patients with a negative DSA and hemodynamic instability (EE group, 3/10 vs NE group, 10/12, p = .027). Major ischemic complications occurred in one patient (TE group). Overall, the in-hospital mortality rate was 7.1% (6/85). Empiric cone-beam CT-guided embolization proved to be a feasible, effective, and safe treatment strategy to reduce rebleeding and improve clinical success in hemodynamically unstable patients with acute LGIB, positive CTA but negative DSA. • A novel transarterial embolization technique guided by cone-beam CT could be developed extending the "empiric" embolization strategy to lower gastrointestinal bleeding. • By implementing the empiric treatment strategy, nearly all patients with an active lower gastrointestinal bleeding on CTA will be eligible for a superselective empiric embolization, even if subsequent catheter angiography is negative. • In patients with a negative catheter angiography, empiric embolization reduces the rebleeding rate and, particularly in hemodynamically unstable patients, improves clinical success compared with a conservative "wait-and-see" management.

Acute lower gastrointestinal bleeding during the COVID-19 pandemic – less is more!

Acute lower gastrointestinal bleeding during the COVID-19 pandemic – less is more!

ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study

ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in...

Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding.

The optimal timing of colonoscopy in acute lower gastrointestinal bleeding (LGIB) remains controversial. To characterise the utility of early colonoscopy (within 24 hours) in managing acute LGIB. A systematic literature search to October 2019 identified fully published articles and abstracts of randomised controlled trials (RCTs) and observational studies with control groups assessing early colonoscopy in acute LGIB. The primary outcome was rebleeding. Secondary outcomes included mortality, surgery, length of stay (LOS), definite cause of bleeding and adverse events. Odds ratios (ORs) and mean differences (MD) were calculated. Of 1116 citations, 4 RCTs (466 patients) and 13 observational studies with elective colonoscopy (>24hours) as control group (1061281 patients) were included. No differences in rebleeding were noted between early and elective colonoscopy groups among RCTs alone (OR=1.70; 0.79; 3.64), or observational studies alone (OR=1.20; 0.69; 2.09). No other significant between-group differences in outcomes were found when restricting the analysis to RCTs. Among observational studies only, early colonoscopy was associated with lower rates of all-cause mortality (OR=0.86; 0.75; 0.98), surgery (OR=0.52; 0.42; 0.64), blood transfusion (OR=0.81; 0.75; 0.87), units of blood transfusion (MD=-4.30; -6.24; -2.36) and shorter LOS (MD=-1.70; -1.70; -1.70days). In contradistinction to observational studies, data from RCTs do not support a role for early colonoscopy in the routine management of acute LGIB with regards to the most important clinical outcomes. Further research is needed to better identify patients with high-risk LGIB who may benefit from early colonoscopy.

External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US

Lower gastrointestinal bleeding (LGIB), which manifests as blood in the colon or anorectum, is a common reason for hospitalization. In most patients, LGIB stops spontaneously with no in-hospital intervention. A risk score that could identify patients at low risk of experiencing adverse outcomes could help improve the triage process and allow greater numbers of patients to receive outpatient management of LGIB. To externally validate the Oakland Score, which was previously developed using a score threshold of 8 points to identify patients with LGIB who are at low risk of adverse outcomes. This multicenter prognostic study was conducted in 140 US hospitals in the Hospital Corporation of America network. A total of 46 179 adult patients (aged ≥16 years) admitted to the hospital with a primary diagnosis of LGIB between June 1, 2016, and October 15, 2018, were initially identified using diagnostic codes. Of those, 51 patients were excluded because they were more likely to have upper gastrointestinal bleeding, leaving a study population of 46 128 patients with LGIB. For the statistical analysis of the Oakland Score, an additional 8061 patients were excluded because they were missing data on Oakland Score components or clinical outcomes, resulting in 38 067 patients included in the analysis. The study used area under the receiver operating characteristic curves with 95% CIs for external validation of the model. Sensitivity and specificity were calculated for each score threshold (≤8 points, ≤9 points, and ≤10 points). Data were analyzed from October 16, 2018, to September 4, 2019. Identification of patients who met the criteria for safe discharge from the hospital and comparison of the performance of 2 score thresholds (≤8 points vs ≤10 points). Safe discharge was defined as the absence of blood transfusion, rebleeding, hemostatic intervention, hospital readmission, and death. Among 46 128 adult patients with LGIB, the mean (SD) age was 70.1 (16.5) years; 23 091 patients (50.1%) were female. Of those, 22 074 patients (47.9%) met the criteria for safe discharge from the hospital. In this group, the mean (SD) age was 67.9 (18.1) years, and 11 056 patients (50.1%) were female. In the statistical analysis of the Oakland Score, which included only the 38 067 patients with complete data, the area under the receiver operating characteristic curve for safe discharge was 0.87 (95% CI, 0.87-0.87). An Oakland Score threshold of 8 points or lower identified 3305 patients (8.7%), with a sensitivity and specificity for safe discharge of 98.4% and 16.0%, respectively. Extension of the Oakland Score threshold to 10 points or lower identified 6770 patients (17.8%), with a sensitivity and specificity for safe discharge of 96.0% and 31.9%, respectively. In this study, the Oakland Score consistently identified patients with acute LGIB who were at low risk of experiencing adverse outcomes and whose conditions could safely be managed without hospitalization. The score threshold to identify low-risk patients could be extended from 8 points or lower to 10 points or lower to allow identification of a greater proportion of low-risk patients.

Mo1730 CONTINUOUS ADMINISTRATION OF ANTITHROMBOTIC DRUGS DOES NOT EXACERBATE ACUTE LOWER GASTROINTESTINAL BLEEDING: POST-HOC ANALYSIS OF A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Currently, there is no established guideline for the continue or discontinue of antithrombotic drugs such as antiplatelet drugs and anticoagulants for patients with gastrointestinal bleeding. Previous retrospective reports suggest that the continuation of antithrombotic drugs increase the risk of early rebleeding. However, discontinuation of antithrombotic drugs has been suggested as a possibility of increased cerebrocardiovascular events and mortality. We conducted a multicenter randomized controlled trial (RCT) on the usefulness of early colonoscopy for acute lower gastrointestinal bleeding (ALGIB) in collaboration with 14 facilities. In the present study, we compared the effects of continuation and discontinuation of antithrombotic drugs for ALGIB as a post-hoc analysis of the RCT. Among 162 patients who visited the hospital for ALGIB between June 2016 and May 2018, 87 were taking antithrombotic drugs. We divided the patients into antithrombotic drugs continuation (n=55) and discontinuation (n=32) groups when they underwent colonoscopy. As a post-hoc analysis, the early rebleeding rate (within 30 days), blood transfusion, the stigmata of recent hemorrhage (SRH) identification rate, additional treatment (endoscopy, interventional radiology, surgery), and adverse events (thrombosis and mortality) were compared between the two groups. Student’s t-test was used for continuous variables, and chi-square test was used for categorical variables. Mantel-Haenszel analysis was performed by adjusting facilities and operators. There was no difference in the type of antithrombotic drugs and bleeding source in the patient background. The early rebleeding rate was not significantly different between the continuation (14.5%) and discontinuation groups (3.1%) (P = 0.14, 95% confidence interval [CI]: -22.1% to -10.3%). The SRH identification rate was not significantly different between the continuation (23.6%) and discontinuation groups (25.0%) (P = 0.98, 95% CI: -19.5% to -19.1%). Blood transfusion, additional treatment such as endoscopic hemostasis or surgery or interventional radiology was not significantly different in either group. No mortality or thrombosis occurred in either group within the 30-day observation period. Reports regarding the continuation of antithrombotic drugs and the course of bleeding such as early rebleeding and blood transfusion were rare. Furthermore, the use of patient data from multicenter RCT is novel. Continuous administration of antithrombotic drugs did not exacerbate ALGIB. This suggests that colonoscopy with continued antithrombotic drug administration should be considered.

Computed tomography versus lower endoscopy as initial diagnostic method for evaluating patients with hematochezia at emergency room.

For acute lower gastrointestinal bleeding (LGIB), lower gastrointestinal endoscopy is the preferred initial diagnostic test. However, it is difficult to perform urgently. Computed tomography (CT) is a convenient alternative.This study aimed to determine the diagnostic performance of CT compared to lower endoscopy as an initial test for evaluating acute LGIB.The medical records of 382 patients who visited our emergency department with hematochezia between January 2012 and January 2017 were retrospectively analyzed. Of them, 112 underwent CT, 65 underwent colonoscopy, and 205 underwent sigmoidoscopy as an initial test. For each method, sensitivity, specificity, positive predictive value, and negative predictive value were calculated upon active bleeding site detection and LGIB etiology diagnosis.The sensitivity, specificity, positive predictive value, and negative predictive value of CT for active bleeding site detection were 85.7%, 100%, 100%, and 96.9%, respectively, while those for identifying the etiology of LGIB were 87.4%, 40.0%, 83.5, and 47.6%, respectively.CT was not inferior to lower endoscopy for active bleeding site detection. Early localization and the exclusion of active bleeding were possible with CT. Etiology was diagnosed with high sensitivity and PPV by CT. Thus, CT can be an alternative initial diagnostic tool for evaluating acute LGIB.

Outcomes in lower GI bleeding comparing weekend with weekday admission

Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization potentially requiring urgent intervention, which may not be readily available at weekends and off-hours. The aim of this study was to examine the association between weekend admission for LGIB and mortality, time to colonoscopy, length of stay, and hospital charges. The 2016 U.S. National Inpatient Sample (NIS) dataset was queried for admissions with a primary diagnosis of LGIB. Outcomes for weekend versus weekday admissions were compared using survey-adjusted chi-squared or bivariate correlation. Multivariable regression was then used to compare primary outcomes adjusting for the Elixhauser mortality score (a validated measure of comorbidities), colonoscopy, transfusion, shock, and hospital type. An estimated 124,620 patients were admitted for LGIB in 2016. Comparing weekend with weekday admissions, there was no difference in unadjusted mortality (0.9% vs 1.0%, P= .636). Colonoscopy within the first day (28.6% vs 23.0%, P< .001) and transfusion (34.0% vs 31.5%, P< .001) were more common with weekday admissions; no differences in colonoscopy rate (60.7% vs 60.9%, P= .818), angiography rate (2.7% vs 2.7%, P= .976), mean days to colonoscopy (2.0 vs 2.0, P= .233), or length of stay (4.2 vs 4.1 days, P= .068) were seen. There was no difference in multivariable adjusted mortality rates (odds ratio, 1.11; 95% confidence interval, 0.81-1.54; P= .495) based on the above factors. Early colonoscopy (within the first day) is more common for weekday admissions, but overall outcomes are not affected by weekend admission for LGIB compared with weekday admissions.

The presentation of Crohn's disease with acute massive gastrointestinal hemorrhage

AbstractSevere gastrointestinal (GI) hemorrhage is a rare initial presentation in Crohn's disease (CD) and poses a therapeutic challenge for clinical care. Currently, there is no conclusive consensus or guideline on the treatment modalities for CD‐related GI bleeding. We present the case of a 21‐year‐old man with acute lower GI bleeding who accepted transcatheter arterial embolization to attain hemostasis. After 1 day of embolization, intractable abdominal pain happened and emergent laparoscopic exploration was arranged. Operation finding reported stenosis and chronic inflammation changes near ileal‐cecal valve. Besides, several bleeding sites and perforation are detected, which is different from splanchnic branch of embolization. Pathology of resected bowel reported transmural acute and chronic inflammation with fibrin and purulent exudates is shown on the serosa. CD is favored. In CD, the most common bleeding site in the literature is located at descending and sigmoid colon. To attain hemostasis, some literature studies raise concerns about embolic‐related complication of intestinal infarction. We would like to share a case of unusual bleeding site and provide consideration of embolization as an option for the treatment of CD.

Development and Validation of a Scoring System to Predict Severe Acute Lower Gastrointestinal Bleeding in Vietnamese.

The prevalence of acute lower gastrointestinal bleeding (ALGIB) has progressively increased worldwide but there are few studies in Asian populations. This study aimed to develop and validate a scoring system to predict severe ALGIB in Vietnamese. Risk factors for severe ALGIB were identified by multiple logistic regression analysis using data from a retrospective cohort of 357 patients admitted to a tertiary hospital. These factors were weighted to develop the severe acute lower gastrointestinal bleeding (SALGIB) score to predict severe ALGIB. The performance of SALGIB was validated in a prospective cohort of 324 patients admitted to 6 other hospitals using area under the receiver operating characteristics curve (AUC) analysis. There were four factors at admission independently associated with severe ALGIB in the derivation cohort: heart rate ≥ 100/min, systolic blood pressure < 100mmHg, hematocrit < 35%, and platelets ≤ 150 × 103/µL. The SALGIB score determined severe ALGIB with AUC values of 0.91 and 0.86 in the derivation and validation cohorts, respectively. A SALGIB score < 2 associated with low risk of severe ALGIB in both cohorts (3.7% and 1.2%; respectively). The SALGIB score has good performance in discriminating risk of severe ALGIB in Vietnamese.

CME Exam 1: An Unusual Cause of Acute Massive Lower Gastrointestinal Bleeding

CME Exam 1: An Unusual Cause of Acute Massive Lower Gastrointestinal Bleeding

Immediate unprepared polyethylene glycol-flush colonoscopy in elderly patients with severe lower gastrointestinal bleeding.

Colon preparation is vital yet more difficult in elderly patients with severe lower gastrointestinal bleeding (LGIB). The aim of this study is to show the efficacy, safety and outcomes of unprepared polyethylene glycol (PEG)-flush retrograde colon cleansing in the diagnosis and treatment of elderly home care patients with LGIB. A single-center study was performed between January 2014 and June 2018. Elderly home healthcare patients presenting with hematochezia were enrolled, and an unprepared retrograde bowel cleansing colonoscopy was performed within the first 8 h after admission to the emergency department. PEG solution (2 L) was added to the water jet tank, and jet pump injection was started from the left side of the colon to the right segment of the colon and ended up at the cecum. In total, 33 elderly patients presenting with hematochezia were evaluated. Mean inward and outward procedure times were 17.06 ± 4.92 (8-33 min) and 28.66 ± 6.88 (10-30 min), respectively. Most of the bleeding was localized in the right colon at 22 patients (66.3%). Endoscopic treatment was performed in 87.9% of patients. The average length of stay in hospital was 44.70 ± 42.81 (range 18.00-240.00 h). Immediate unprepared PEG-flush colonoscopy in elderly home care patients with acute LGIB is a safe and effective method, which detects bleeding sources and provides endoscopic therapy. With this procedure, the time of hospital stay is reduced. This approach may be used for the initial intervention in patients admitted to emergency departments or intensive care unit with severe acute LGIB. Geriatr Gerontol Int 2020; ••: ••-••.

Prediction Model for 30-day Outcomes Among Emergency Department Patients with Lower Gastrointestinal Bleeding.

IntroductionThere are currently no robust tools available for risk stratification of emergency department (ED) patients with lower gastrointestinal bleed (LGIB). Our aim was to identify risk factors and develop a preliminary model to predict 30-day serious adverse events among ED LGIB patients.MethodsWe conducted a health records review including adult ED patients with acute LGIB. We used a composite outcome of 30-day all-cause death, recurrent LGIB, need for intervention to control the bleeding, and severe adverse events resulting in intensive care unit admission. One researcher collected data for variables and a second researcher independently collected 10% of the variables for inter-observer reliability. We used backward multivariable logistic regression analysis and SELECTION=SCORE option to create a preliminary risk-stratification tool. We assessed the diagnostic accuracy of the final model.ResultsOf 372 patients, 48 experienced an adverse outcome. We found that age ≥75 years, hemoglobin ≤100 g/L, international normalized ratio ≥2.0, ongoing bleed in the ED, and a medical history of colorectal polyps were statistically significant predictors in the multivariable regression analysis. The area under the curve (AUC) for the model was 0.83 (95% confidence interval, 0.77–0.89). We developed a scoring system based on the logistic regression model and found a sensitivity 0.96 (0.90–1.00) and specificity 0.53 (0.48–0.59) for a cut-off score of 1.ConclusionThis model showed good ability to differentiate patients with and without serious outcomes as evidenced by the high AUC and sensitivity. The results of this study could be used in the prospective derivation of a clinical decision tool.

Urgent Versus Standard Colonoscopy for Management of Acute Lower Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization. However, the optimum timing of colonoscopy following patient presentation remains unclear. This systematic review and meta-analysis aims to evaluate the effect of urgent versus standard colonoscopy timing on management of acute LGIB. Medline, EMBASE, CENTRAL, and PubMed were searched up to January 2020. Randomized controlled trials were eligible for inclusion if they compared patients with hematochezia receiving urgent (<24 h) versus standard (>24 h) colonoscopy. Nonrandomized observational studies were also included based on the same criteria for additional analysis. Pooled estimates were calculated using random effects meta-analyses and heterogeneity was quantified using the inconsistency statistic. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Of 3782 potentially relevant studies, 4 randomized controlled trials involving 463 patients met inclusion criteria. Urgent colonoscopy did not differ significantly to standard timing with respect to length of stay (LOS), units of blood transfused, rate of additional intervention required, or mortality. Colonoscopy-related outcomes such as patient complications, rebleeding rates, and diagnosis of bleeding source did not differ between groups. However, meta-analysis including nonrandomized studies (9 studies, n=111,950) revealed a significantly higher rate of mortality and complications requiring surgery in the standard group and shorter LOS in the urgent group. Overall GRADE certainty of evidence was low in the majority of outcomes. Timing of colonoscopy in acute LGIB may not significantly affect patient outcomes. Timing should therefore be decided on a case-by-case basis.

CTA measurements of acute lower gastrointestinal bleeding size predict subsequent positive catheter angiography.

The purpose of this study was to determine whether the measured size of active gastrointestinal hemorrhage was useful in predicting subsequent positive findings at catheter angiography. This was a single-institution retrospective study consisting of 32 patients with computed tomography angiography (CTA) positive for gastrointestinal bleeding who went on to receive catheter angiography. Each CTA was reviewed, with axial measurements of the anterior-posterior and transverse dimensions of the largest foci of hemorrhage recorded. Volumetric analysis was used to measure the volume of hemorrhage. These measurements were performed for both the arterial and portal venous phases. Additionally, the interval growth between the arterial and portal venous phase was also calculated. There was a statistically significant difference in the absolute size of the maximum transverse dimension on portal venous phase imaging (mean = 19.8mm, p < 0.001), as well as an interval increase in transverse (mean = 8.5mm, p < 0.001) and anteriorposterior (mean = 5.4mm, p = 0.027) size between arterial and portal venous phases in patients with positive catheter angiography versus negative catheter angiography. There was a statistically significant difference in the volume of hemorrhage on arterial (mean = 1.72cm3, p = 0.020) and portal venous phases (mean = 5.89cm3, p = 0.016), as well as an interval change in the size of hemorrhage between the two phases (mean = 4.17cm3, p = 0.020) in patients with positive catheter angiography versus patients in the negative catheter angiography group. The absolute axial size and volume of hemorrhage, as well as the interval change between the arterial and portal venous phases of CTA imaging is predictive of subsequent positive catheter angiography.

Is Early Colonoscopy Required in Acute Lower Gastrointestinal Bleeding?

Is Early Colonoscopy Required in Acute Lower Gastrointestinal Bleeding?

Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding 1）.

Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding^1）.

Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study.

AimClinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non‐endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy.MethodsWe undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in‐hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score‐matched analyses were undertaken to adjust for confounders.ResultsWe identified 6,546 eligible patients. The patients were divided into the colonoscopy group (n = 5,737) and angiography group (n = 809). After one‐to‐four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in‐hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group.ConclusionsThe present study revealed that in‐hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.

Endoscopic Band Ligation for Acute Lower Gastrointestinal Bleeding.

Objective Endoscopic band ligation (EBL) is commonly performed to treat colonic diverticular bleeding (CDB). However, EBL is not suitable for other disorders that cause acute lower gastrointestinal bleeding (ALGIB), and the safety and efficacy of the procedure are not well known. This study aimed to evaluate the efficacy and safety of EBL for non-colonic diverticular bleeding (non-CDB) and investigate the application of EBL to ALGIB. Methods This study was a retrospective evaluation of the success rate of EBL, the rate of early re-bleeding (within 30 days of the initial EBL), and complications such as perforation and abscess formation. Patients Thirty patients who presented with non-CDB and underwent EBL as the first-line treatment in our hospital from June 2009 to December 2017 were included in the present study. Results The success rate of EBL was 93% (28/30). The rate of early re-bleeding after EBL was 20% (6/30). Repeat EBL, endoscopic clipping, or conservative therapy was performed in the event of re-bleeding. No emergency surgery or interventional hemostatic treatments were required for hemostasis. No complications such as perforation or abscess formation were observed in any patient. Conclusion Our results suggest that EBL is an effective and safe endoscopic treatment for non-CDB.