Dr Don Rockey and colleagues from North Carolina conducted a prospective randomized study comparing urgent colonoscopy to standard care.
The research team hypothesized that early intervention in patients with lower gastrointestinal bleeding would improve outcomes.
The team included 50 consecutive patients presenting with lower gastrointestinal bleeding without upper or anorectal bleeding sources.
The patients were randomized to urgent purge preparation followed immediately by colonoscopy in Group 1 or a standard care algorithm in Group 2.
Standard care algorithm was based on angiographic intervention and expectant colonoscopy.
The team found a definite source of bleeding more often in urgent colonoscopy patients than in the standard care group.
|Mortality occurred in 2% with urgent colonoscopy vs 4% with standard care algorithm|
|American Journal of Gastroenterology|
In the urgent colonoscopy group, 17 patients received endoscopic therapy, while in the standard care group, 10 patients had angiographic hemostasis.
The researchers noted no difference in outcomes among the 2 groups.
The team observed mortality in 2% of Group 1 vs 4% of Group 2.
Hospital stay was 6 days in Group 1 vs 7 days in Group 2, and intensive care stay was about 2 days in both groups, although slightly less in Group 1.
The researchers found that transfusion requirements were at 4 units in Group 1 vs 5 units in Group 2.
Early rebleeding occurred in 22% of Group 1 vs 30% of Group 2, and late rebleeding was 16% vs 14% in these groups.
The team observed that surgery was required in 14% of Group 1 vs 12% of Group 2.
Dr Rockey's team concluded, “Urgent colonoscopy identifies a definite source of lower gastrointestinal bleeding more often than a standard care algorithm based on angiography and expectant colonoscopy”
“However, the approaches are not significantly different with regard to important outcomes.”
“Thus, decisions concerning care for patients with acute lower gastrointestinal bleeding should be based on individual experience and local expertise.”