Acute Lower Intestinal Bleeding Research Articles

683 - Use of the Strate Score and Glasgow Blatchford Score(GBS) for Risk Stratification of Patients with Acute Lower Intestinal Bleeding – A Retrospective Observational Study

683 - Use of the Strate Score and Glasgow Blatchford Score(GBS) for Risk Stratification of Patients with Acute Lower Intestinal Bleeding – A Retrospective Observational Study

Neural network prediction of severe lower intestinal bleeding and the need for surgical intervention

BackgroundThe prognosis for patients with severe acute lower intestinal bleeding (ALIB) may be assessed by complex artificial neural networks (ANNs) or user-friendly regression-based models. Comparisons between these modalities are limited, and predicting the need for surgical intervention remains elusive. We hypothesized that ANNs would outperform the Strate rule to predict severe bleeding and would also predict the need for surgical intervention. MethodsWe performed a 4-y retrospective analysis of 147 adult patients who underwent endoscopy, angiography, or surgery for ALIB. Baseline characteristics, Strate risk factors, management parameters, and outcomes were analyzed. The primary outcomes were severe bleeding and surgical intervention. ANNs were created in SPSS. Models were compared by area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals. ResultsThe number of Strate risk factors for each patient correlated significantly with the outcome of severe bleeding (r = 0.29, P < 0.001). However, the Strate model was less accurate than an ANN (AUROC 0.66 [0.57-0.75] versus 0.98 [0.95-1.00], respectively) which incorporated six variables present on admission: hemoglobin, systolic blood pressure, outpatient prescription for Aspirin 325 mg daily, Charlson comorbidity index, base deficit ≥5 mEq/L, and international normalized ratio ≥1.5. A similar ANN including hemoglobin nadir and the occurrence of a 20% decrease in hematocrit was effective in predicting the need for surgery (AUROC 0.95 [0.90-1.00]). ConclusionsThe Strate prediction rule effectively stratified risk for severe ALIB, but was less accurate than an ANN. A separate ANN accurately predicted the need for surgery by combining risk factors for severe bleeding with parameters quantifying blood loss. Optimal prognostication may be achieved by integrating pragmatic regression-based calculators for quick decisions at the bedside and highly accurate ANNs when time and resources permit.

Amphetamine-Related Ischemic Colitis Causing Gastrointestinal Bleeding

A 43-year-old woman presented with acute lower intestinal bleeding requiring blood transfusion. Multiple initial investigations did not reveal the cause of the bleeding. Colonoscopy performed 2 days later showed features suggestive of ischemic colitis. On detailed history, the patient admitted to using amphetamines, and her urine drug screen was positive for them. She was managed conservatively and advised not to use amphetamines again. She did not have any recurrence on 2-year follow-up.

An unusual case of intramural Meckel's diverticulum as a lead point for ileoileal intussusception – Laparoscopically assisted management

Intussusception is a frequent cause of intestinal obstruction in children. Ileoileal intussusception is rare and it is secondary to pathological or congenital lead points. We report an unusual case of an intramural Meckel's diverticulum as a lead point for ileoileal intussusception presenting with acute lower intestinal bleeding. Laparoscopically assisted resection of the involved ileum was successfully accomplished.

120 Roles of PKCs and PKD in Mechanotranscription in Colonic Smooth Muscle Cells: Inhibition of Mechanotranscription as a Potential Treatment for Motility Dysfunction in Obstructive Disorders

Background: Acute lower gastrointestinal bleeding (LGIB) accounts for about 30 percent of episodes of gastrointestinal bleeding. It encompasses a wide spectrum of symptoms ranging from trivial hematochezia to massive hemorrhage with shock. Identifying those who will later develop severe bleeding is a challenge. Strate and colleagues have identified predictors of severity in patients with acute lower intestinal bleeding. The aim of this study was to provide external validation for the Strate clinical prediction rule for severe acute LGIB. Methods: We retrospectively selected patients with a principal diagnosis of LGIB between January 2007 and August 2011 at a busy urban hospital. Predictor variables were those from Strate's original study: heart rate ≥ 100/min, systolic blood pressure ≤ 115 mmHg, syncope, nontender abdominal exam, rectal bleeding in the first 4 hours of evaluation, aspirin use, and >2 comorbid conditions. Severe LGIB was defined as the presence of any of the following: transfusion of ≥2 units of red blood cells in the first 24 hours, recurrent rectal bleeding after 24 hours of stability (requiring additional blood transfusions), need for ICU placement or readmission for acute LGIB within one week of discharge. An overall risk score was created by adding the number of predictive factors present. Patients were stratified into 3 risk groups: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). Results: Analysis was performed on 378 patients. The risk of severe bleeding in each category was: low risk 31%, moderate risk 55%, and high risk 84%. The area under the receiver operating characteristic curve (AUROC) was 0.70 with good calibration (H-L chi sq.= 0.98). The magnitude of the risk score was significantly correlated with need for blood transfusions, ICU placement and length of stay but not with need for surgery or death. Inclusion of additional variables including age, gender, actual heart rate and systolic blood pressure did not improve the AUROC for the prediction of severe bleeding. Conclusions: Strate and colleagues developed a promising clinical prediction rule for acute severe LGIB. The risk factors are simple and available within 4 hours of presentation. However, we find the predictive ability of the rule to be lower than in the original study as evidenced by the lower AUROC (0.70 versus 0.75). The Strate LGIB score does not have sufficient discriminatory power to improve the triage of patients to appropriate levels of care, nor promote a more standardized approach to acute LGIB. Further research is needed to improve our ability to identify patients presenting with LGIB who are at high risk for severe bleeding.

122 Cholecystokinin-8 Regulates Pacemaker Activities in Cultured Interstitial Cells of Cajal From Murine Small Intestine

Background: Acute lower gastrointestinal bleeding (LGIB) accounts for about 30 percent of episodes of gastrointestinal bleeding. It encompasses a wide spectrum of symptoms ranging from trivial hematochezia to massive hemorrhage with shock. Identifying those who will later develop severe bleeding is a challenge. Strate and colleagues have identified predictors of severity in patients with acute lower intestinal bleeding. The aim of this study was to provide external validation for the Strate clinical prediction rule for severe acute LGIB. Methods: We retrospectively selected patients with a principal diagnosis of LGIB between January 2007 and August 2011 at a busy urban hospital. Predictor variables were those from Strate's original study: heart rate ≥ 100/min, systolic blood pressure ≤ 115 mmHg, syncope, nontender abdominal exam, rectal bleeding in the first 4 hours of evaluation, aspirin use, and >2 comorbid conditions. Severe LGIB was defined as the presence of any of the following: transfusion of ≥2 units of red blood cells in the first 24 hours, recurrent rectal bleeding after 24 hours of stability (requiring additional blood transfusions), need for ICU placement or readmission for acute LGIB within one week of discharge. An overall risk score was created by adding the number of predictive factors present. Patients were stratified into 3 risk groups: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). Results: Analysis was performed on 378 patients. The risk of severe bleeding in each category was: low risk 31%, moderate risk 55%, and high risk 84%. The area under the receiver operating characteristic curve (AUROC) was 0.70 with good calibration (H-L chi sq.= 0.98). The magnitude of the risk score was significantly correlated with need for blood transfusions, ICU placement and length of stay but not with need for surgery or death. Inclusion of additional variables including age, gender, actual heart rate and systolic blood pressure did not improve the AUROC for the prediction of severe bleeding. Conclusions: Strate and colleagues developed a promising clinical prediction rule for acute severe LGIB. The risk factors are simple and available within 4 hours of presentation. However, we find the predictive ability of the rule to be lower than in the original study as evidenced by the lower AUROC (0.70 versus 0.75). The Strate LGIB score does not have sufficient discriminatory power to improve the triage of patients to appropriate levels of care, nor promote a more standardized approach to acute LGIB. Further research is needed to improve our ability to identify patients presenting with LGIB who are at high risk for severe bleeding.

119 Validation of a Predictive Rule for Severe Acute Lower Intestinal Bleeding

Background: Acute lower gastrointestinal bleeding (LGIB) accounts for about 30 percent of episodes of gastrointestinal bleeding. It encompasses a wide spectrum of symptoms ranging from trivial hematochezia to massive hemorrhage with shock. Identifying those who will later develop severe bleeding is a challenge. Strate and colleagues have identified predictors of severity in patients with acute lower intestinal bleeding. The aim of this study was to provide external validation for the Strate clinical prediction rule for severe acute LGIB. Methods: We retrospectively selected patients with a principal diagnosis of LGIB between January 2007 and August 2011 at a busy urban hospital. Predictor variables were those from Strate's original study: heart rate ≥ 100/min, systolic blood pressure ≤ 115 mmHg, syncope, nontender abdominal exam, rectal bleeding in the first 4 hours of evaluation, aspirin use, and >2 comorbid conditions. Severe LGIB was defined as the presence of any of the following: transfusion of ≥2 units of red blood cells in the first 24 hours, recurrent rectal bleeding after 24 hours of stability (requiring additional blood transfusions), need for ICU placement or readmission for acute LGIB within one week of discharge. An overall risk score was created by adding the number of predictive factors present. Patients were stratified into 3 risk groups: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). Results: Analysis was performed on 378 patients. The risk of severe bleeding in each category was: low risk 31%, moderate risk 55%, and high risk 84%. The area under the receiver operating characteristic curve (AUROC) was 0.70 with good calibration (H-L chi sq.= 0.98). The magnitude of the risk score was significantly correlated with need for blood transfusions, ICU placement and length of stay but not with need for surgery or death. Inclusion of additional variables including age, gender, actual heart rate and systolic blood pressure did not improve the AUROC for the prediction of severe bleeding. Conclusions: Strate and colleagues developed a promising clinical prediction rule for acute severe LGIB. The risk factors are simple and available within 4 hours of presentation. However, we find the predictive ability of the rule to be lower than in the original study as evidenced by the lower AUROC (0.70 versus 0.75). The Strate LGIB score does not have sufficient discriminatory power to improve the triage of patients to appropriate levels of care, nor promote a more standardized approach to acute LGIB. Further research is needed to improve our ability to identify patients presenting with LGIB who are at high risk for severe bleeding.

CT Angiography for Acute Lower Intestinal Bleeding

Usual diagnostic modalities to detect the source of acute lower gastrointestinal bleeding (colonoscopy, scintigraphy with technetium-labeled red cells,

Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography

To assess the diagnostic performance of computed tomographic (CT) angiography as the initial diagnostic examination for patients presenting to the emergency room with acute lower intestinal bleeding. The study was reviewed and approved by the ethics committee, and written informed consent was obtained from each patient or their closest relative when the clinical condition precluded consent by the patient. This prospective study comprised 47 patients (27 men, 20 women; mean age, 68 years) with acute lower gastrointestinal tract bleeding who were referred to undergo emergency colonoscopy for evaluation. CT angiography was performed in all patients shortly after arrival to the emergency room. Findings identified at CT angiography included active extravasation (ongoing hemorrhage) or hyperattenuating intraluminal contents on noncontrast material-enhanced images (recent hemorrhage). Presence and location of bleeding and likely cause of hemorrhage were determined and compared with the standard of reference (angiography, colonoscopy, or surgical findings). Data collected were analyzed with a statistical software package. Sensitivity, specificity, and positive and negative predictive values of CT angiography in depicting ongoing or recent hemorrhage were calculated and compared with those of standard of reference. CT angiography demonstrated active bleeding in 14 patients and intraluminal hyperattenuating material in six patients. The sensitivity, specificity, positive predictive value, and negative predictive value of CT angiography in depicting active or recent bleeding were 100% (19 of 19), 96% (27 of 28), 95% (19 of 20), and 100% (27 of 27), respectively. Findings of CT angiography and the standard of reference were concordant for determining definite or potential cause of bleeding in 44 of 47 patients (93% accuracy). CT angiography performed in the emergency setting in patients with acute lower intestinal bleeding is feasible and correctly depicts the presence and location of active or recent hemorrhage, as well as the potential cause, in the majority of patients.

Exam 1: The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding

Exam 1: The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding

The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding

There are multiple strategies for evaluating and treating lower intestinal bleeding (LIB). Colonoscopy has become the preferred initial test for most patients with LIB because of its diagnostic and therapeutic capabilities and its safety. However, few studies have directly compared colonoscopy with other techniques and there are controversies regarding the optimal timing of colonoscopy, the importance of colon preparation, the prevalence of stigmata of hemorrhage, and the efficacy of endoscopic hemostasis. Angiography, radionuclide scintigraphy, and multidetector computed tomography scanning are complementary modalities, but the requirement of active bleeding at the time of the examination limits their routine use. In addition, angiography can result in serious complications. This review summarizes the available evidence regarding colonoscopy and radiographic studies in the management of acute LIB.

Noninvasive Imaging and Radiovirotherapy of Prostate Cancer Using an Oncolytic Measles Virus Expressing the Sodium Iodide Symporter

Prostate cancer cells overexpress the measles virus (MV) receptor CD46. Herein, we evaluated the antitumor activity of an oncolytic derivative of the MV Edmonston (MV-Edm) vaccine strain engineered to express the human sodium iodide symporter (NIS; MV-NIS virus). MV-NIS showed significant cytopathic effect (CPE) against prostate cancer cell lines in vitro. Infected cells effectively concentrated radioiodide isotopes as measured in vitro by Iodide-125 ((125)I) uptake assays. Virus localization and spread in vivo could be effectively followed by imaging of (123)I uptake. In vivo administration of MV-NIS either locally or systemically (total dose of 9 x 10(6) TCID(50)) resulted in significant tumor regression (P < 0.05) and prolongation of survival (P < 0.01). Administration of (131)I further enhanced the antitumor effect of MV-NIS virotherapy (P < 0.05). In conclusion, MV-NIS is an oncolytic vector with significant antitumor activity against prostate cancer, which can be further enhanced by (131)I administration. The NIS transgene allows viral localization and monitoring by noninvasive imaging which can facilitate dose optimization in a clinical setting.

Endoscopic Management of Massive Acute Lower Gastrointestinal Bleeding

Background: The management of moderate or massive acute lower intestinal bleeding (ALIB) is not well established. Although there are several strategies for the diagnosis and treatment of patients with ALIB we believe that colonoscopy within 6 hours of its presentation can be performed safely with a high rate of success in localizing and often treating the specific cause of bleeding. Aim: To assess the role of early colonoscopy as the primary method of evaluation in patients with ALIB. Methods: From January 1986 to October 2008, 29209 colonoscopies were performed in the endoscopy unit of Sírio Libanês Hospital, Sao Paulo. Two hundred and thirty (0,79%) were urgent due to ALIB. After clinical stabilization the patients received an anterograde bowel preparation and the exams were done always under sedation. Results: Definitive diagnosis was accurate in 147 patients (64%). Diverticula (16 patients), Post-Polypectomy (16) and Angiodysplasia (14) were the predominant sources of bleeding. In 69 patients (49%) a specific therapeutic intervention was done, including fulguration (13 patients), endoscopic injection of sclerosing agents (34), APC (10), metallic endoscopic clips (10) and elastic band ligation (2). Control of active hemorrhage was achieved endoscopically in 100% of these patients. Conclusions: These data shows the importance of early colonoscopy in the management of patients with acute lower intestinal bleeding making possible its diagnosis and treatment.

Risk Factors for Mortality in Lower Intestinal Bleeding

Previous studies of lower intestinal bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB. We used the 2002 Healthcare Cost and Utilization Project Nationwide Inpatient Sample to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified by using multiple logistic regression. In 2002, an estimated 8737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs <50 years; odds ratio [OR], 4.91; 95% confidence interval [CI], 2.45-9.87), intestinal ischemia (OR, 3.47; 95% CI, 2.57-4.68), comorbid illness (>or=2 vs 0 comorbidities, OR, 3.00; 95% CI, 2.25-3.98), bleeding while hospitalized for a separate process (OR, 2.35; 95% CI, 1.81-3.04), coagulation defects (OR, 2.34; 95% CI, 1.50-3.65), hypovolemia (OR, 2.22; 95% CI, 1.69-2.90), transfusion of packed red blood cells (OR, 1.60; 95% CI, 1.23-2.08), and male gender (OR, 1.52; 95% CI, 1.21-1.92). Colorectal polyps (OR, 0.26; 95% CI, 0.15-0.45), and hemorrhoids (OR, 0.42; 95% CI, 0.28-0.64) were associated with a lower risk of mortality, as was diagnostic testing for LIB when added to the multivariate model (OR, 0.37; 95% CI, 0.28-0.48). Hospital characteristics were not significantly related to mortality. Predictors of mortality were similar in an analysis restricted to patients with diverticular bleeding. The all-cause in-hospital mortality rate in LIB was low (3.9%). Advanced age, intestinal ischemia, and comorbid illness were the strongest predictors of mortality.

External Validation of the Strate's Predictive Model of Severity in Lower Intestinal Bleeding

Introduction: Acute lower intestinal bleeding (LIB) is a common medical emergency. Recently Strate et al. developed and validated a predictive model to assess the severity of acute LIB. Generalisability of a prediction rule in clinical practice requires an external validation in other clinical contexts. Objective: External validation of the Strate severity index for LIB. Patients and Methods: Design: Prospective, cohort study. Patients (validation cohort): Patients admitted to our hospital with the diagnosis of LIB from April 2005 to April 2007.

A Clinical-Endoscopic Risk Score to Predict Outcome in Acute Lower Intestinal Bleeding (LIB)

A Clinical-Endoscopic Risk Score to Predict Outcome in Acute Lower Intestinal Bleeding (LIB)

Validation of a Clinical Prediction Rule for Severe Acute Lower Intestinal Bleeding

Validation of a Clinical Prediction Rule for Severe Acute Lower Intestinal Bleeding

Validation of a Clinical Prediction Rule for Severe Acute Lower Intestinal Bleeding

Acute lower intestinal bleeding is a heterogeneous disorder and identification of high-risk patients is challenging. We previously retrospectively identified predictors of severity in patients with acute lower intestinal bleeding. The aim of this study was to prospectively validate a clinical prediction rule for severe acute lower intestinal bleeding. This was a prospective, observational cohort study of consecutive patients admitted to an academic, tertiary care or a community-based teaching hospital for management of acute lower intestinal bleeding. Data were collected on seven previously identified predictors of severe bleeding: heart rate > or = 100/min, systolic blood pressure < or = 115 mmHg, syncope, nontender abdominal exam, rectal bleeding in the first 4 h of evaluation, aspirin use, and >2 comorbid conditions. Severe bleeding was defined as transfusion of > or =2 units of red blood cells, and/or a decrease in hematocrit of > or =20% in the first 24 h, and/or recurrent rectal bleeding after 24 h of stability (accompanied by a further decrease in hematocrit of > or =20%, and/or additional blood transfusions, and/or readmission for acute lower intestinal bleeding within 1 wk of discharge). Patients were stratified into 3 risk groups according to the previously developed prediction rule: low (no risk factors), moderate (1-3 risk factors), and high (>3 risk factors). A total of 275 patients with acute lower intestinal bleeding were identified. The risk of severe bleeding in each risk category was similar in the validation and derivation cohorts (p values >0.05): low risk 6%versus 9%, moderate risk 43%versus 43%, and high risk 79%versus 84%. The area under the receiver operating characteristic curve was 0.754 for the validation cohort and 0.761 for the derivation cohort. The magnitude of the risk score was significantly correlated with major clinical outcomes including surgery, death, blood transfusions, and length of stay. We have developed and prospectively validated a clinical prediction rule for acute severe lower intestinal bleeding. This prediction rule could improve the triage of patients to appropriate levels of care and interventions, and guide a more standardized approach to acute lower intestinal bleeding.

Predictors of Mortality in Acute Lower Intestinal Bleeding in a Nationally Representative Sample

Background & Aim: Existing data regarding acute lower intestinal bleeding (ALIB) derive from small cohorts, limiting the assessment of rare outcomes such as mortality. The aim of this study was to investigate the epidemiology of ALIB including predictors of mortality using a nationwide database. Methods: Data were obtained from a 20% sample of the 2002 National Inpatient Sample (NIS) of the Health Care and Utilization Project (HCUP) and were analyzed to generate weighted national estimates. The NIS is the largest all-payer inpatient database in the US representing approximately 8 million hospital discharges. Patients with a primary diagnosis of ALIB were identified using an algorithm of 60 ICD-9-CM diagnostic codes. Patients with diagnoses representative of upper, chronic or nonspecific intestinal bleeding were excluded. Analyses were performed using SAS-callable SUDAAN to account for complex sampling design. Results: In 2002, there were an estimated 526,752 discharges with the principal diagnosis of acute lower intestinal bleeding in the US and 16,329 deaths (mortality 3.1%). Fourteen percent of discharges were in patients < 50 years of age, 26% 50-70 years and 60% > 70 years; 56% were female. Common bleeding diagnoses included: diverticular (42%), hemorrhoids (21%), polyp (12%), angiodysplasia (6%), ischemia (5%), radiation colitis (5%) and IBD (3%). Colonoscopy was performed in 52%, endoscopic hemostasis in 4%, EGD in 26%, flexible sigmoidoscopy in 4%, angiography in 2%, nuclide scan in 1%, and surgery in 1%. In the adjusted analysis, factors associated with increased mortality were (OR, 95% CI): increasing age (1.05, 1.04-1.06), ischemia (3.5, 2.28-5.39), surgery (3.15, 1.41-7.06) and Deyo comorbidity score: 1 (1.78, 1.26-2.51), ≥ 2 (2.73, 1.91-3.90). Bleeding from polyps (0.24, 0.11-0.52) and diverticulosis (0.68, 0.50-0.93) was independently associated with improved survival. Conclusions: Although the risk of death in ALIB is low, overall mortality is significant. Advanced age, surgical intervention, comorbid illness and colonic ischemia all increase the risk of mortality. Patients with bleeding from diverticulosis or polyps have improved survival.

Early Colonoscopy and Hospital Length of Stay in Acute Lower Intestinal Bleeding: A Nationwide Study

Background & Aims: Several single-center studies suggest that early performance of colonoscopy in Acute Lower Intestinal Bleeding (ALIB) shortens hospital length of stay (LOS). We examined predictors of LOS in ALIB using a nationally representative sample. Methods: A 20% sample of the 2002 National Inpatient Sample (NIS) part of the Health Care and Utilization Project (HCUP) was used to derive national weighted estimates. The NIS is a 20% stratified sample of all US community hospitals, representing nearly 8 million hospital discharges from 995 hospitals. Patients with a primary diagnosis of ALIB were selected using an algorithm of 60 ICD-9-CM discharge codes, excluding patients with diagnoses of upper, chronic or nonspecific intestinal bleeding. All analyses were performed using SAS-callable SUDAAN to account for complex sampling. Cox proportional hazards regression with inpatient death as the censored event was used for analyses of LOS (time to discharge). Results: Nationwide in 2002, there were an estimated 526,752 discharges with the principal diagnosis of ALIB. Fifty-six percent were female and the mean age was 70 years (interquartile range, 59-81). Common bleeding diagnoses included diverticular (42%), hemorrhoids (21%), polyp (12%), angiodysplasia (6%), ischemia (5%), and IBD (3%). Colonoscopy was performed in 52% of admissions; 57% were performed during the first day of admission (early colonoscopy). The mean hospital LOS was 6 days (interquartile range 1.8-6.2). Mean LOS was 4.7 days in admissions with early colonoscopy compared to 6.4 days in patients without (p<0.01). In the adjusted analysis, early colonoscopy was associated with a shorter LOS (hazard ratio [HR], 95% CI) (1.39,1.32-1.47). Other independent correlates of a shorter LOS included private insurance (1.25, 1.16-1.34), hemorrhoidal bleeding (1.23, 1.16-1.31) and diverticular bleeding (1.11, 1.06-1.17). Surgical intervention was independently associated with a longer LOS (0.35, 0.3-0.4), as was Deyo comorbidity score [1 (0.78, 0.74-0.82), ≥ 2 (0.62, 0.58-0.66)], ischemia (0.71, 0.65-0.77), blood transfusion(s) (0.75, 0.71-0.79), age > 70 years (0.91, 0.85-0.98), and black race (0.91, 0.85-0.98). Use of endoscopic hemostasis and weekend admission were not significantly related to LOS. Conclusions: In this nationwide study, early colonoscopy was associated with shorter hospital length of stay, though this effect did not appear to be the result of therapeutic interventions.