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No improvement in re-bleeding rate with earlier colonoscopy for patients hospitalized with lower gastrointestinal bleed
Clinical Question
For patients hospitalized with acute lower gastrointestinal bleeding, does colonoscopy within 24 hours lead to better outcomes?
Bottom line
Both observational data and data from randomized controlled trials (RCTs) show no significant difference in re-bleeding rates when comparing early colonoscopy (within 24 hours of presentation) with elective colonoscopy (after 24 hours) for patients admitted to the hospital with lower gastrointestinal bleeding. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Inpatient (any location)
Synopsis
These investigators searched multiple databases including OVID, MEDLINE, and EMBASE to find RCTs and observational studies that evaluated early colonoscopy, defined as colonoscopy performed within 24 hours of presentation, for patients hospitalized with lower gastrointestinal bleeding. Two authors independently assessed studies for inclusion and study quality. Overall, 4 RCTs (n = 466) and 13 observational studies (n = 1,061,281) that compared early colonoscopy with elective colonoscopy (after 24 hours) were selected. Pooling the data from either the RCTs alone or the observational studies alone revealed no significant difference between the 2 groups in the primary outcome of the rate of re-bleeding. Results of the secondary outcomes were inconsistent between the 2 study types. Although the observational study data noted an association of early colonoscopy with lower rates of all-cause mortality, need for surgery, and need for blood transfusion, as well as a decreased length of stay, the RCT data did not show significant differences in any of these secondary outcomes. Further research with larger RCTs is needed to reconcile these findings.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
early colonoscopy
It sounds like there are long term advantages to doing this.
Timing of colonoscopy with lower GI bleeds
It may be that outcomes are no different with earlier colonoscopy, but I think it is better for patient anxiety and for the medical team to know the cause of the bleed and start planning management. Not necessarily within 24 hours, but within a few days.
colonoscopy within 24 hours of gi bleed
there is some time to wait to do colonoscopy unless extensive bleeding that is unstable
No improvement in re-bleeding rate with earlier colonoscopy
Depends on the subset of patients