Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, Chicago, Illinois.
Center for Health and Social Sciences, University of Chicago Medical Center, Chicago, Illinois.
Clin Gastroenterol Hepatol. 2019 May;17(6):1105-1111.e1. doi: 10.1016/j.cgh.2018.09.050. Epub 2018 Oct 6.
BACKGROUND & AIMS: Colonoscopy within 24 hours (early colonoscopy) is recommended for patients with colonic diverticular bleeding, but it is unclear if this strategy improves postdischarge outcomes. We aimed to determine whether early colonoscopy is associated with decreased risk of rebleeding and hospital re-admission within 30 days.
We performed a retrospective cohort study using Marketscan (Truven Health Analytics, Inc, Ann Arbor, MI), a nationwide insurance claims database. From January 2004 through September 2015, patients with a primary diagnosis of diverticular bleeding who underwent inpatient colonoscopy were included. We used propensity score matching to account for differences between recipients of early vs delayed colonoscopy. Multivariable logistic regression was performed to determine the association between early colonoscopy and rebleeding or hospital re-admission within 30 days of discharge.
In total, 20,010 patients underwent colonoscopy for diverticular bleeding; 11,690 underwent early colonoscopy. After propensity matching, 8320 pairs of patients were analyzed. In the matched analysis, higher proportions of patients who received early colonoscopy underwent additional colonoscopies (73%), compared with patients who did not receive early colonoscopy (4%) (P < .0001), but lower proportions received endoscopic interventions (3% vs 8%; P < .0001). On multivariable analysis, early colonoscopy (odds ratio [OR], 1.34; 95% CI, 1.08-1.66; P = .007), transfusion requirement (OR, 2.31; 95% CI, 1.88-2.83; P < .0001), and baseline chronic kidney disease (OR, 2.13; 95% CI, 1.49-3.04; P < .0001) were associated with increased risk of rebleeding within 30 days. Early colonoscopy (OR, 1.18; 95% CI, 1.02-1.36; P = .03), endoscopic intervention (OR, 1.37; 95% CI, 1.03-1.81; P = .03), transfusion requirement (OR, 2.17; 95% CI, 1.88-2.51; P < .0001), coronary artery disease (OR, 1.27; 95% CI, 1.06-1.51; P = .009), and chronic kidney disease (OR, 1.98; 95% CI, 1.54-2.54; P < .0001) were associated with increased re-admission to the hospital within 30 days.
In a propensity-matched analysis, we associated early colonoscopy with increased risk of rebleeding events and hospital re-admissions. However, these observations might be due to confounding factors.
对于患有结肠憩室出血的患者，建议在 24 小时内进行结肠镜检查（早期结肠镜检查），但目前尚不清楚这种策略是否能改善出院后的结果。我们旨在确定早期结肠镜检查是否与 30 天内再出血和再次住院的风险降低有关。
我们使用 Marketscan（Truven Health Analytics，Inc，密歇根州安阿伯）进行了一项回顾性队列研究，这是一个全国性的保险索赔数据库。从 2004 年 1 月到 2015 年 9 月，对接受住院结肠镜检查的患有憩室出血的患者进行了分析。我们使用倾向评分匹配来解释早期结肠镜检查与延迟结肠镜检查之间的差异。多变量逻辑回归用于确定早期结肠镜检查与出院后 30 天内再出血或再次住院之间的关联。
共有 20,010 名患者因憩室出血而行结肠镜检查；其中 11,690 人接受了早期结肠镜检查。经过倾向评分匹配后，分析了 8320 对患者。在匹配分析中，与未接受早期结肠镜检查的患者（4%）相比，接受早期结肠镜检查的患者接受了更多的结肠镜检查（73%）（P<0.0001），但接受内镜介入治疗的比例较低（3%比 8%）（P<0.0001）。多变量分析显示，早期结肠镜检查（比值比[OR]，1.34；95%可信区间[CI]，1.08-1.66；P=0.007）、输血需求（OR，2.31；95%CI，1.88-2.83；P<0.0001）和基线慢性肾脏病（OR，2.13；95%CI，1.49-3.04；P<0.0001）与 30 天内再出血风险增加有关。早期结肠镜检查（OR，1.18；95%CI，1.02-1.36；P=0.03）、内镜介入治疗（OR，1.37；95%CI，1.03-1.81；P=0.03）、输血需求（OR，2.17；95%CI，1.88-2.51；P<0.0001）、冠心病（OR，1.27；95%CI，1.06-1.51；P=0.009）和慢性肾脏病（OR，1.98；95%CI，1.54-2.54；P<0.0001）与 30 天内再次住院有关。
在倾向评分匹配分析中，我们发现早期结肠镜检查与再出血事件和再次住院的风险增加有关。然而，这些观察结果可能是由于混杂因素所致。
