Background Data on the role of colonoscopy in hematochezia are almost exclusively derived from clinical experience in tertiary care practice. Objective To characterize the patient population who received colonoscopy for hematochezia in a consortium of diverse gastroenterology practices. Design Retrospective analysis. Setting Clinical Outcomes Research Initiative Database, 2002 to 2008. Patients Adults undergoing colonoscopy for the indication of hematochezia. Main Outcome Measurements Demographics, comorbidity, practice setting, adverse events, and colonoscopy procedure characteristics and findings. Age-stratified analyses and analyses of inpatient- versus outpatient-performed colonoscopies were also performed. Results A total of 966,536 colonoscopies were performed during the study period, 76,186 (7.9%) were performed for evaluation of hematochezia. The majority of patients were white non-Hispanic men younger than 60 years old who underwent colonoscopy at a community practice site (79.1%) and had a low-risk American Society of Anesthesiologists (ASA) score (81.5%), in whom colonoscopy reached the cecum (94.8%), and serious adverse events were rare. Colonoscopy findings were hemorrhoids (64.4%), diverticulosis (38.6%), and polyp or multiple polyps (38.8%). From the overall cohort, 38.3% were 60 years of age and older. The older age cohort had significantly more white non-Hispanic females, high-risk ASA scores, incomplete colonoscopies, and unplanned events. Colonoscopy findings demonstrated significantly higher rates of diverticulosis, polyp or multiple polyps, mucosal abnormality/colitis, tumor, and solitary ulcer (P .0001). There were 3941 (5.2%) who underwent inpatient performed colonoscopy. One third of this cohort (32.6%) was defined as having a high ASA score. Limitations Retrospective database review. Conclusions These results describe patient populations and characterize colonoscopy findings in individuals presenting with hematochezia primarily in a community practice setting.

Background Data on use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings. Objective To characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who received endoscopic hemostasis with those who did not receive endoscopic hemostasis. Design Retrospective analysis Setting Clinical Outcomes Research Initiative (CORI) National Endoscopic Database 2002 – 2008 Patients Adults with hematochezia Interventions None Main Outcome Measurements Demographics, co-morbidity, practice setting, adverse events, and colonoscopy procedural characteristics and findings. Results We identified 3,151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), White (83.3%), older (mean age 70.9 ± 12.3 years), had a low risk ASA Score (53.9%), and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be White (83.3% vs. 71.0%, p=0.02), have more co-morbidities (ASA Score III and IV 46.2% vs. 36.0%, p=0.04), and have the cecum reached (95.8% vs. 87.7%, p=0.003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of AVM’s (32.6% vs. 2.6%) p=0.0001or solitary ulcer (8.3% vs. 2.1%), p<0.0001. Limitations Retrospective database analysis. Conclusions Less than five percent of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights on in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia.

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