Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding on the Basis of Propensity Score Matching Analysis

Nagata, Naoyoshi; Niikura, Ryota; Sakurai, Toshiyuki; Shimbo, Takuro; Aoki, Tomonori; Moriyasu, Shiori; Sekine, Katsunori; Okubo, Hidetaka; Imbe, Koh; Watanabe, Kazuhiro; Yokoi, Chizu; Yanase, Mikio; Akiyama, Junichi; Uemura, Naomi

doi:10.1016/j.cgh.2015.10.011

Cited by 70 publications

(116 citation statements)

References 18 publications

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“…In a study conducted by Niikura et al [22], the identification of SRH was improved by colonoscopy (i) when performed within 24 h, (ii) by expert endoscopists who have performed > 1,000 colonoscopies, and (iii) with the use of disposable distal attachments and water-jet systems. Although the primary treatment outcome was not to improve the identification rate of SRH in the studies, other studies have also reported that bowel preparation with oral lavage solutions and colonoscopy performed within 24 h improve the identification rate of SRH [35,71,74,76,83]. Statement: There are several endoscopic hemostatic methods including epinephrine injection, coagulation, clipping, and ligation (EBL and detachable snare ligation), among which ligation is less frequently associated with transition to arterial embolization and surgery, suggesting that it is more effective than the other methods.…”

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 93%

“…ly phase and those who waited some interval before undergoing colonoscopy [71][72][73]. Two of these 3 studies included 2 randomized controlled studies [35,36], 4 observational studies, and 1 retrospective cohort study that involved propensity score matching [74] and the results revealed a significantly higher rate of identifying the source of bleeding in the early colonoscopy group, with no significant difference in rebleeding rate, in-hospital mortality, or rate of transition to surgery [71,72]. In contrast, the third study that included 2 randomized controlled studies and 10 observational studies found that the rate of performing endoscopic therapy was significantly higher in the early colonoscopy group, with no significant difference in the rate of identifying the source of bleeding, unexpected complications, rebleeding, blood transfusion, or death [73].…”

Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

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Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 93%

Section: Cq10: Is It Effective To Perform Colonoscopy For Acute Lgib mentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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“…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…”

Section: Diagnosismentioning

confidence: 99%

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

Oakland

Chadwick

East

et al. 2019

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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“…1,2 Many need repeated blood transfusions, interventions such as colonoscopic, radiological, and surgical treatment, as well as longer hospitalization that substantially increase costs. Therefore, to improve the triage of appropriate patients to emergency hospitalization or early intervention, physicians should understand the predictive factors for severe…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding

Aoki

Nagata

Shimbo

et al. 2016

Clinical Gastroenterology and Hepatology

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Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding on the Basis of Propensity Score Matching Analysis

Cited by 70 publications

References 18 publications

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

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

Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding

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