Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
J Gastroenterol Hepatol. 2022 Jul;37(7):1290-1297. doi: 10.1111/jgh.15839. Epub 2022 Apr 3.
Early colonoscopy has not shown any advantages over elective colonoscopy in reducing the risk of early rebleeding (≤ 30 days) after acute lower gastrointestinal bleeding (ALGIB). Considering the heterogeneity among patients with ALGIB, we sought to evaluate appropriate candidates for early colonoscopy.
A total of 592 patients with ALGIB were enrolled, and the clinical outcomes of early colonoscopy were investigated. Thereafter, the participants were divided into two groups: the recent bleeding group (n = 445), with hematochezia 0-6 h before hospital arrival, and non-recent bleeding group (n = 147). The clinical outcomes yielded by early colonoscopy were assessed in each group.
The multivariate analysis including the entire population revealed that early colonoscopy (< 24 h) did not reduce the risk of early rebleeding (adjusted odds ratio [AOR], 0.88; 95% confidence interval [CI], 0.55-1.39). However, in the subgroup analysis, early colonoscopy independently reduced the risk of early rebleeding in the recent bleeding group (AOR, 0.56; 95% CI, 0.33-0.94). Moreover, a reduction in the need for radiological or surgical intervention (AOR, 0.34), transfusion (AOR, 0.62), and prolonged hospitalization (AOR, 0.42), as well as improvement in diagnostic yield (AOR, 1.78) and endoscopic treatment rates (AOR, 1.66), were observed. Early colonoscopy did not improve the outcomes of the non-recent bleeding group.
Early colonoscopy is not required for all patients with ALGIB. However, it may be suitable for those with hematochezia 0-6 h before hospital arrival, as it reduces early rebleeding and improves clinical outcomes.
早期结肠镜检查并未显示出在降低急性下消化道出血（ALGIB）后早期再出血（≤30 天）风险方面优于择期结肠镜检查。考虑到 ALGIB 患者的异质性，我们试图评估适合早期结肠镜检查的合适人选。
共纳入 592 例 ALGIB 患者，研究早期结肠镜检查的临床结果。此后，将患者分为两组：近期出血组（n=445），就诊前 0-6 小时有血便；非近期出血组（n=147）。评估每组中早期结肠镜检查的临床结果。
包括整个人群的多变量分析显示，早期结肠镜检查（<24 小时）并未降低早期再出血的风险（调整后的优势比 [AOR]，0.88；95%置信区间 [CI]，0.55-1.39）。然而，在亚组分析中，早期结肠镜检查可独立降低近期出血组早期再出血的风险（AOR，0.56；95%CI，0.33-0.94）。此外，降低了放射学或手术干预（AOR，0.34）、输血（AOR，0.62）和住院时间延长（AOR，0.42）的需求，以及提高了诊断率（AOR，1.78）和内镜治疗率（AOR，1.66）。早期结肠镜检查并未改善非近期出血组的结局。
并非所有 ALGIB 患者都需要进行早期结肠镜检查。然而，对于就诊前 0-6 小时有血便的患者，早期结肠镜检查可能是合适的，因为它可以降低早期再出血的风险并改善临床结局。
