Is Early Colonoscopy Necessary for Patients With Acute Lower GI Bleeding?

Patients hospitalized with acute lower gastrointestinal bleeding (LGIB) do not require early colonoscopy to reduce additional bleeding or risk of mortality, according to the findings of a meta-analysis of randomized trials.

The researchers noted that current guidance, which calls for performing colonoscopy within 24 hours for patients who present with LGIB, relied primarily on meta-analyses of observational studies.

To conduct their systematic analysis, the research team analyzed data from 4 randomized trials that compared the outcomes of participants who received colonoscopy within 24 hours of admission for LGIB (early) and those who had later colonoscopies and/or other diagnostic procedures and tests.

The primary outcome for this study was continued persistent or recurrent bleeding following the participant’s initial examination. The secondary outcomes assessed were mortality; identification of the source of bleeding (diagnostic yield); endoscopic intervention; and any other primary hemostatic intervention using endoscopy, surgery, or interventional radiology.

Results showed that participants who underwent colonoscopy within 24 hours did not experience a decrease in further bleeding when compared with the participants who had elective colonoscopy at a later time.   

Further, the researchers found no significant differences in mortality, diagnostic yield, endoscopic intervention, or any primary hemostatic intervention.

“We found that colonoscopy within 24 hours does not reduce further bleeding or mortality in patients hospitalized with acute LGIB,” the researchers concluded. “Based on these findings, patients hospitalized with acute LGIB do not generally require early colonoscopy.”

—Rebecca Mashaw

Reference:

Tsay C, Shung D, Stemmer Frumento K, Laine L. Early colonoscopy does not improve outcomes of patients with lower gastrointestinal bleeding: systematic review of randomized trials. Clin Gastroenterol Hepatol. 2020;18(8):1696-1703. https://doi.org/10.1016/j.cgh.2019.11.061