Large RCT Shows No Benefit of Early Colonoscopy in Patients With Acute LGIB
A benefit of early colonoscopy (in the first 24 hours) after hospitalization for acute lower-GI bleeding (LGIB) remains uncertain. In a large, randomized, controlled trial (RCT) of 159 patients in 15 hospitals in Japan, patients were randomized to colonoscopy within 24 hours of admission versus 24 to 96 hours after admission (elective colonoscopy). Severe bleeding (hemoglobin <8, systolic blood pressure <90, or pulse >100) occurred in 39.2% of the early group versus 26.3% of the elective group, with the remainder of acute LGIB characterized as moderate.
The mean interval to colonoscopy was 13.9 hours in the early group and 41.8 hours in the elective group. Stigmata of recent hemorrhage were identified in 21.5% of the early group versus 21.3% of the elective group. Failure to establish any likely lower-GI source occurred in 16% of both groups. Endoscopic treatment was feasible in 15 patients in each group. Rebleeding within 30 days occurred in 15.3% of the early group versus 6.7% of the elective group (P=0.09). There was no difference in adverse events.
Comment:
Limitations in drawing conclusions include the low fraction of patients with severe hemorrhage. In addition, relatively early colonoscopy may still be more likely to identify stigmata because the mean time to colonoscopy in the elective group was 41 hours from admission, and the latest colonoscopy to identify stigmata was at 44 hours. Nevertheless, this large RCT suggests no substantial benefit for early colonoscopy in patients with acute LGIB.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
Citation(s):
Niikura R, Nagata N, Yamada A, et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology 2019 Sep 26. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2019.09.010) )
