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Early colonoscopy may improve detection of bleeding source in LGIB patients

19 Apr 2017

No association exists between early colonoscopy and reduced rebleeding, length of stay (LOS) or surgery in patients with severe lower gastrointestinal bleeding (LGIB), according to a new study. However, early colonoscopy correlates with a higher rate of source localization and endoscopic intervention.

A meta-analysis was conducted on studies comparing early (<24 hours) vs delayed colonoscopy (>24 hours). Researchers accessed PubMed, Embase and Web of Science for manuscripts using colonoscopy as a diagnostic/treatment modality for patients hospitalized with LGIB. Only studies with available data on outcomes comparing early and delayed colonoscopy were included in the analysis.

The following factors were reviewed in the included articles: time to colonoscopy, rebleeding, mortality, LOS, surgery, interventions, localization of LGIB and number of packed red blood cells. The Mantel-Haenszel method was used to report pooled measures.

Of the 8,491 studies evaluated, only six were included in the meta-analysis, which involved 422 patients in the early arm and 479 in the delayed arm.

There were no between-group differences in age (64.2 vs 65.7; p=0.85), admission haemoglobin (10.3 vs 10.3 g/dL; p=0.96), LOS (5.21 vs 6.09; p=0.52) and packed red blood cells transfusion (2.37 vs 2.35; p=0.92). There was also no difference in rebleeding (odds ratio [OR], 1.38; 95 percent CI, 0.85 to 2.23), need for surgery (OR, 0.89; 0.42 to 1.89) and in hospital mortality (OR, 1.64; 0.51 to 5.32) between early and delayed colonoscopy.

On the other hand, early colonoscopy showed an association with a higher detection of bleeding source (OR, 2.97; 2.11 to 4.19) and endoscopic intervention (OR, 3.99; 2.59 to 6.13).

Early colonoscopy is recommended for LGIB patients, said researchers, adding that data regarding its association with improved outcomes is limited.

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