Colonoscopy For Lower Gastrointestinal Bleeding Research Articles

Disease patterns among Saudi children undergoing colonoscopy for lower gastrointestinal bleeding: Single tertiary care center experience.

: The yield of colonoscopy in cases presenting with lower gastrointestinal bleeding (LGIB) in previously published studies varies according to several factors, including endoscopic skills, histopathological experience, and pattern of colonic pathology in different countries. The local literature is limited to a single small 20-year-old study. Our objective was to provide updated data on the diagnostic yield of colonoscopy in Saudi children with LGIB in Saudi Arabia. : This was a retrospective analysis of pediatric patients (0-14 years of age) who underwent colonoscopy for LGIB at the King Fahad Medical City (KFMC), from 2008 to 2018. LGIB was defined as fresh or dark blood per rectum. : During the study period, 175 children underwent colonoscopy for LGIB (99 males, mean age 7.05 ± 3.81 years), which constituted 53.5% of indications for colonoscopy procedures (n = 327) in our center. The terminal ileum was intubated in 81% of the procedures. Overall, inflammatory bowel disease (IBD) was the most commonly identified cause of LGIB (32% ) followed by colonic lymphonodular hyperplasia (CLNH) in 17% and juvenile polyp and rectal mucosal prolapse syndrome (RMPS), 11% each. On sub-analysis, cow's milk protein allergy (CMPA) and CLNH were the most common causes in infants and toddlers, 35% each; IBD (26.5%) and polyps (22.4%) in young children (2-6 years), and IBD (36%), CLNH (14.9%) and RMPS (14%) in older children (6-14 years). In comparing the IBD to the non-IBD group, IBD patients were older (mean 8.37 vs. 6.46 years, P = 0.002) and more likely to have diarrhea, weight loss, high erythrocyte sedimentation rate, anemia, and hypoalbuminemia (odds ratio 24, 11, 10.7, 6.5, and 4, respectively). Colonoscopy had a sensitivity of 97%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81.4%, and accuracy of 97% in diagnosing LGIB. : Colonoscopy is an effective diagnostic tool in children with LGIB with a high diagnostic yield. Besides IBD, CLNH and RMPS are two other important pathologic entities that need to be considered in a child with LGIB.

Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States.

BACKGROUNDLower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings. AIMTo investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals. METHODSThis is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost. RESULTSOur study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs. CONCLUSIONAlthough there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.

Outcomes of Early versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database: 2016 ACG Fellows-In-Training Award (Colon Category)

Outcomes of Early versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database: 2016 ACG Fellows-In-Training Award (Colon Category)

Endoscopic Management of Acute Lower Gastrointestinal Bleeding

Lower gastrointestinal bleeding (LGIB) continues to be a problem for physicians. Acute LGIB is defined as bleeding that emanates from a source distal to the ligament of Treitz. Although 80% of all LGIB will stop spontaneously, the identification of the bleeding source remains challenging and rebleeding can occur in 25% of cases. Diverticular bleeding remains the most common cause of lower GI bleeding. Lower Gastrointestinal Bleeding encompasses a wide clinical spectrum ranging from occult bleeding to overt hematochezia until massive hemorrhage with shock requiring emerging hospitalization. Some patients with severe hematochezia require urgent attention to minimize further bleeding and complications. Colonoscopy is the diagnostic procedure of choice in most patients with Lower GI bleeding and its role in the treatment of lower GI bleeding has been shown to be an efficacious and safe method even if a therapeutic endoscopy occurred in about 30% of patients. The optimal timing of colonoscopy in LGIB remains to be determined. CT angiography is used in the setting of acute Lower GI bleeding correctly depicts the presence and location of active or recent hemorrhage, as well as the potential cause, in about 80-85% of case. Nuclear scintigraphy has been proposed as a diagnostic screening prior to angiography, increasing the likelihood of positive angiographic results or as a tool for localization for surgery but had multiple limitations. Superselective mesenteric angiography remains the cornerstone of management of patients with acute LGIB but it is an invasive and time-consuming procedure. Emergent surgery should be considered only as a last resort and is rarely needed to prevent death from exanguination. The golden standard for surgical treatment of acute severe LGIB should be directed segmental resection based on aggressive preoperative identification of the bleeding site. This article reviews the causes, clinical presentation, diagnostic methods, endoscopic treatment of LGIB and management of specific LGI bleeding lesions.

Utility of urgent colonoscopy in acute lower gastro-intestinal bleeding: a single-center experience

Background. The role of urgent colonoscopy in lower gastro-intestinal bleeding (LGIB) remains controversial. Over the last two decades, a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions; however, studies comparing this approach to elective colonoscopy for LGIB are limited.Aims. To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit (ICU) with acute LGIB.Methods. Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively. Patients were grouped into urgent vs. elective colonoscopy, depending on the timing of colonoscopy after admission to the ICU. Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective. Outcomes included length of hospital stay, early re-bleeding rates, and the need for additional diagnostic or therapeutic interventions. Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements.Results. Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB, 24 of which were urgent. There was no significant difference in patient demographics, co-morbidities, or medications between the two groups. Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability (P = 0.019) and require blood transfusions (P = 0.003). No significant differences in length of hospital stay, re-bleeding rates, or the need for additional diagnostic or therapeutic interventions were found. Patients requiring blood transfusions (n = 27) were more likely to be female (P = 0.016) and diabetics (P = 0.015). Fourteen patients re-bled at a median of 2 days after index colonoscopy. Those with hemodynamic instability were more likely to re-bleed [HR 3.8 (CI 1.06–13.7)], undergo angiography [HR 9.8 (CI 1.8–54.1)], require surgery [HR 13.5 (CI 3.2–56.5)], and had an increased length of hospital stay [HR 1.1 (1.05–1.2)].Conclusion: The use of urgent colonoscopy, as an initial approach to investigate acute LGIB, did not result in significant differences in length of ICU stay, re-bleeding rates, the need for additional diagnostic or therapeutic interventions, or 30-day mortality compared with elective colonoscopy. In a pre-specified subgroup analysis, patients with hemodynamic instability were more likely to re-bleed after index colonoscopy, to require additional interventions (angiography or surgery) and had increased length of hospital stay.

Mo1617 Utility of Urgent Colonoscopy in Acute Lower Gastrointestinal Bleeding: a Single Center Experience

Background. The role of urgent colonoscopy in lower gastro-intestinal bleeding (LGIB) remains controversial. Over the last two decades, a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions; however, studies comparing this approach to elective colonoscopy for LGIB are limited. Aims. To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit (ICU) with acute LGIB. Methods. Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively. Patients were grouped into urgent vs. elective colonoscopy, depending on the timing of colonoscopy after admission to the ICU. Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective. Outcomes included length of hospital stay, early re-bleeding rates, and the need for additional diagnostic or therapeutic interventions. Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements. Results. Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB, 24 of which were urgent. There was no significant difference in patient demographics, co-morbidities, or medications between the two groups. Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability ( P= 0.019) and require blood transfusions ( P= 0.003). No significant differences in length of hospital stay, re-bleeding rates, or the need for additional diagnostic or therapeutic interventions were found. Patients requiring blood transfusions ( n= 27) were more likely to be female ( P= 0.016) and diabetics ( P= 0.015). Fourteen patients re-bled at a median of 2 days after index colonoscopy. Those with hemodynamic instability were more likely to re-bleed [HR 3.8 (CI 1.06–13.7)], undergo angiography [HR 9.8 (CI 1.8–54.1)], require surgery [HR 13.5 (CI 3.2–56.5)], and had an increased length of hospital stay [HR 1.1 (1.05–1.2)]. Conclusion: The use of urgent colonoscopy, as an initial approach to investigate acute LGIB, did not result in significant differences in length of ICU stay, re-bleeding rates, the need for additional diagnostic or therapeutic interventions, or 30day mortality compared with elective colonoscopy. In a pre-specified subgroup analysis, patients with hemodynamic instability were more likely to re-bleed after index colonoscopy, to require additional interventions (angiography or surgery) and had increased length of hospital stay.

Urgent Colonoscopy in Lower GI Bleeding: Not So Fast

The role of urgent colonoscopy in lower gastrointestinal bleeding (LGIB) remains controversial. Although some studies have shown that examinations performed within 12-24 h of admission improve diagnostic yield and reduce rebleeding and surgery, others have not. In this issue of the American Journal of Gastroenterology, Laine and Shah present a randomized trial of urgent (<12 h from admission) vs. elective (36-60 h from admission) colonoscopy in 72 patients with LGIB. A total of 15% of patients with presumed LGIB were found to have upper gastrointestinal bleeding, highlighting the importance of excluding a gastroduodenal source in patients with severe hematochezia. The majority of patients with LGIB (72%) stopped bleeding spontaneously, and there were no differences in rebleeding, blood transfusions, diagnostic or therapeutic interventions, length of hospital stay, or hospital charges in patients undergoing urgent vs. elective colonoscopy. However, the limited number of patients in this study and the fact that patients in the urgent colonoscopy arm appeared to have more severe bleeding than those undergoing elective examinations make it difficult to draw conclusions regarding the utility of urgent vs. elective colonoscopy in LGIB.

Colonoscopic Findings in African Americans Referred for Lower Gastrointestinal Bleeding

Purpose: The etiology of lower gastrointestinal bleeding (LGIB) varies widely among different populations of the world with a paucity of data on the African American population. We conducted a study to assess the etiology of lower gastrointestinal bleeding (LGIB) exclusively in African Americans, to compare with available data from North America, and the rest of the world. Lower gastrointestinal bleeding in this study was defined as the presence of occult blood in stool or hematochezia of any amount. Methods: The consecutive medical records of African American patients who were evaluated with colonoscopy for lower gastrointestinal bleeding between January 1, 1999 and May 31, 2000 were reviewed in an inner city teaching hospital. We excluded patients with history of colectomy as well as screening, surveillance, and incomplete colonoscopies. Results: A total of 318 patients' colonoscopic reports and associated biopsy reports were analyzed. 49 (15.4%) were in-patients, and the remaining 269 (84.6%) were out patients with 170 (53.5%) being female. Colonoscopy identified the cause of bleeding in 238 patients (74.8%). The commonest lesions found were adenomatous polyps (25.5%), followed by colitis (acute and chronic) which constituted 16%, diverticulosis 12.3%, carcinoma 7.5%, benign anorectal diseases 5.7% with vascular ectasia being relatively uncommon (0.9%). Our findings are somewhat similar to comparable studies in the US, that show polyps, carcinoma, diverticulosis, inflammatory bowel disease including infectious and ischemic colitis, and vascular ectasia as the descending frequency of occurrence for L.G.I.B. of all types, but at significant variance from comparable study from Africa which has benign anorectal diseases, acute amebic colitis, cancer, and polyps as the descending order of findings. Conclusions: Environmental factors including dietary practices probably play the major role in determining the etiology of lower gastrointestinal bleeding. Further studies are necessary to better define ethnic variations in lower gastrointestinal bleeding.

Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding

To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding. A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan. Fifty-five people undergoing bedside colonoscopy for lower GI bleeding that developed while in the ICU. Bedside colonoscopy. Colonoscopy was successful in diagnosing the source of bleeding in 37 patients. Among them, colitis (15 patients, including ischemic, pseudomembranous, or radiation-induced) and acute hemorrhagic rectal ulcer (nine patients) were the most frequent confirmed causes. In seven patients, fresh blood was noticed above the colonoscopically accessible area and considered to originate from the small bowel. No adverse event was associated with colonoscopy. Spontaneous cessation of bleeding was noted in 29 (29/55, 53%) patients, whereas 16 (16/55, 29%) achieved endoscopic hemostasis. Ten (10/55, 18%) patients failed primary hemostasis or localization. Overall in-hospital mortality was 53% (29/55); however, hemorrhage-related death occurred in only two patients. ICU patients with acute lower GI bleeding have distinctive causes. Bedside colonoscopy is effective for diagnosis in two-thirds of patients, but only a minority of them needs endoscopic hemostasis.

Urgent Colonoscopy to Identify and Treat Diverticular Bleeding

Recent evidence has suggested that, in a significant fraction of patients, urgent purge and colonoscopy for lower gastrointestinal bleeding can