Kalpit Devani, MD, on Early Colonoscopy in Acute Lower GI Bleeding
The use of early colonoscopy in acute lower gastrointestinal (GI) bleeding is steadily increasing, yet it has remained unclear whether the procedure is used routinely across institutions and medical centers, or whether it can improve survival and other outcomes for this patient population.
Kalpit Devani, MD, fellow at East Tennessee State University in Tennessee, is the lead author of a new study1 presented at the American College of Gastroenterology’s Annual Meeting 2018 about the topic and answered our questions about the outcomes of his research.
Gastroenterology Consultant: How did your study come about?
Kalpit Devani: Timing of the colonoscopy in patients admitted with acute lower GI is controversial. Current guidelines recommend colonoscopy to be performed within 24 hours of admission in high-risk patients. So, we wanted to evaluate current practice patterns in the United States for patients admitted with acute lower GI bleeding.
GASTRO CON: Why is the use of early colonoscopy for the management of acute lower GI bleeding increasing?
KD: We think trends in early colonoscopy is increasing for the following reasons: increased awareness amongst clinicians about the condition, easy accessibility to gastroenterology consultation, and constant strive to decrease length of hospitalization.
GASTRO CON: What is the most important takeaway from the results of your study?
KD: Our study details multiple important findings. Early colonoscopy does not improve mortality but does decrease length of stay, and in turn, decreases the cost of hospitalization. This will eventually help decrease health care expenditures. Our study also determined that colonoscopy utilization is associated with improved outcomes in patients hospitalized with acute lower GI bleeding. No colonoscopy is associated with double mortality compared with even late colonoscopy.
GASTRO CON: Your study showed inpatient mortality is unaffected by early colonoscopy. What are other ways early colonoscopy is beneficial for this patient population?
KD: Early colonoscopy can also lead to shorter length of hospital stay and lower cost of hospitalization. This will overall decrease the health care burden from acute lower GI bleeding.
GASTRO CON: What is the next step in your research?
KD: It would be interesting to see a prospective study evaluating whether early colonoscopy would help with early identification and hemostasis of the potential source of bleeding.
For more information about GI bleeding and disorders, visit Gastroenterology Consultant.
Reference:
1) Devani K, Charilaou P, Radadiya D, et al. Trends of early colonoscopy and their outcomes in patients admitted with acute lower gastrointestinal bleeding. Paper presented at: American College of Gastroenterology Annual Meeting 2018; October 5-10, 2018; Philadelphia, PA. https://www.eventscribe.com/2018/ACG/agenda.asp?h=Full%20Schedule&BCFO=P|G. Accessed October 11, 2018.