Editorial: 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.