Colonoscopy Delay in Lower Gastrointestinal Bleeding: Influence On Diagnostic Accuracy, Endoscopic Therapy and Hospital Stay

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

“…Evidence on timing of colonoscopy from observational studies is conflicting and nearly all studies are retrospective. One prospective study, published in abstract form, reported increased diagnostic and therapeutic yields and decreased length of stay with urgent (<24 hours) colonoscopy, although there was no mortality benefit 35. Four further retrospective studies have also suggested increased therapeutic yield, decreased length of stay and reduced transfusion requirements with urgent (<24 hours) colonoscopy; however, none have shown any benefit in reduced mortality9 33 36 37 and one study reported increased rebleed rates in the urgent group 33…”

Rendimiento de la colonoscopia en la hemorragia digestiva baja

“…Sin embargo, predecir el origen y la gravedad del episodio hemorrágico en el momento del ingreso supone un desafío para el clínico. Tabla 1 Causas más frecuentes de hemorragia digestiva baja 2,4,9,14,15,18,27,44 Origen Actualmente disponemos de una gran variedad de exploraciones para el manejo de la HDB. Entre ellas, destacan la colonoscopia, la arteriografía, la gammagrafía con hematíes marcados y la tomografía computarizada.…”

“…En general, la colonoscopia se considera urgente cuando se realiza entre las 12 14,15 y las 24 h desde el ingreso 26,27 . Estudios recientes indican que la práctica precoz de la colonoscopia ofrece ventajas 9,14,15,17,27 con respecto a la electiva, ya que permite un mayor porcentaje de diagnósticos de certeza, una mayor probabilidad de realizar tratamiento endoscópico 14,15,18,26,27 y una menor estancia hospitalaria 17,27 .…”

“…y de realizar un tratamiento endoscópico (OR 0,38; IC 95% 0,16-0,91; p = 0,03) 27 . La probabilidad de detectar una lesión tratable es superior en los episodios de HDB grave 14,15 .…”

Gastrointestinal bleeding

“…Medical treatment alone was as effective as endoscopic treatment (either sclerotherapy or ligation) alone in the prevention of variceal re− bleeding (OR 1.14, 95 %CI 0.79 ± 1.65) and in the reduction of all− cause mortality (OR 0.98, 95 %CI 0.82 ± 1.18). The same group analyzed the influence of timing on the diagnos− tic accuracy of colonoscopy in lower gastrointestinal bleeding [16]. Lower gastrointestinal bleeding !…”