• colonic diverticular bleeding
• colonic diverticular hemorrhage
• endoscopic hemostasis
• epidemiology
• lower gastrointestinal bleeding

• gastrointestinal bleeding
• hemodynamic instability
• meta-analysis
• shock

• Ministry of Innovation and Technology of Hungary

• Acute lower gastrointestinal bleeding
• Cost of hospitalization
• Early colonoscopy
• Length of hospitalization
• Predictive model

• Humans
• Length of Stay
• Retrospective Studies
• Quality of Life
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Colonoscopy

• Colonoscopy
• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans

• Diverticular bleeding
• Prognosis
• Urgent colonoscopy

• P20 GM130457 NIGMS NIH HHS

• endoscopy
• gastrointestinal bleeding
• guidelines
• hemostasis
• non-steroidal anti-inflammatory drugs
• risk factors

• Bleeding
• Cirrhosis
• Hemorrhage
• Portal hypertension
• Pressure

• colonic diverticular bleeding
• length of hospitalization
• urgent colonoscopy

• Aged
• Aged, 80 and over
• Colonoscopy/adverse effects
• Diverticulosis, Colonic/complications
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/therapy
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/adverse effects
• Humans
• Length of Stay
• Male
• Middle Aged
• Patient Admission
• Patient Discharge
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome

• Colonoscopy
• Gastrointestinal hemorrhage

• colonoscopy
• embolisation
• haematochezia
• lower gastrointestinal bleeding

Diverticular bleeding (DB) is the most common cause of severe acute lower gastrointestinal bleeding (GIB) in developed countries. The role of early colonoscopy (<24 hours) continues to remain controversial and data on early colonoscopy in acute DB are scant. We aimed to evaluate the effect of timing of colonoscopy on outcomes in patients with acute DB using a nationwide inpatient sample.

Data from the nationwide inpatient sample from 2012 to 2014 were used. The ninth version of the International Classification of Diseases coding system ICD 9 was used for patient selection. We included discharges with the primary and secondary inpatient diagnosis of diverticulosis with bleeding and diverticulitis with bleeding. Discharges with no primary or secondary diagnosis of diverticulosis with bleeding, diverticulitis with bleeding, patients who were less than 18 years old and those who did not undergo colonoscopy during the admission were excluded. The primary outcomes were length of stay (LOS) and total hospitalization costs.

A total of 88 600 patients were included in our analysis, amongst whom 45 020 (50.8%) had colonoscopy within 24 hours of admission (early colonoscopy), while 43 580 (49.2%) patients had colonoscopy after 24 hours of admission (late colonoscopy). LOS was significantly lower in patients with early colonoscopy as compared to those with late colonoscopy (3.7 vs 5.6 days, P < 0.0001). Total hospitalization costs were also significantly lower in patients with early colonoscopy ($9317 vs $11 767, P < 0.0001). There was no difference in mortality between both groups (0.7 vs 0.8%). After adjusting for potential confounders, the differences in LOS and total hospitalization costs between early and late colonoscopy remained statistically significant.

Early colonoscopy in acute DB significantly reduced LOS and total hospitalization costs. There was no significant difference in mortality observed. Performance of early colonoscopy in the appropriate patients presenting with acute DB can have potential cost-saving implications. Further research is needed to identify which patients would benefit from early colonoscopy in DB.

• Diverticular bleeding
• colonoscopy
• lower gastrointestinal bleeding
• timing of colonoscopy

• Bowel preparation
• CT angiography
• Colonic diverticular hemorrhage
• Colonoscopy

• Bowel preparation
• CT angiography
• Hematochezia
• Hemorrhage
• Length of stay
• Nuclear scintigraphy
• Review

• Colonoscopy
• Hematochezia
• Lower gastrointestinal bleeding

• 急性下消化道大出血
• 急诊肠镜
• 择期肠镜
• 肠道准备方式
• 肠道清洁度
• severe acute lower gastrointestinal bleeding
• urgent colonoscopy
• elective colonoscopy
• bowel preparation
• bowel cleanliness

• Acute Disease
• Cathartics/administration & dosage
• Cathartics/classification
• Colonoscopy/standards
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Time Factors

• Angiography
• Colonoscopy
• Diverticulosis
• Lower gastrointestinal bleeding

• Colonoscopy
• Endoscopy
• GI angiography
• GI bleeding
• GI haemorrhage
• Haematochezia
• Lower GI

• CCI
• CI
• Charlson Comorbidity Index
• HCUP
• Healthcare Cost and Utilization Project
• ICD-9-CM
• International Classification of Diseases, Ninth Revision, Clinical Modification
• LGIB
• LOS
• NIS
• Nationwide Inpatient Sample
• RCT
• aOR
• adjusted odds ratio
• confidence interval
• length of stay
• lower GI bleeding
• randomized, controlled trial

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Colonoscopy/methods
• Confidence Intervals
• Cross-Sectional Studies
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/surgery
• Hemostasis, Endoscopic/methods
• Hospital Mortality/trends
• Humans
• Inpatients
• Length of Stay/trends
• Male
• Middle Aged
• Odds Ratio
• Ohio/epidemiology
• Operative Time
• Population Surveillance
• Prognosis
• Retrospective Studies
• Survival Rate/trends
• Young Adult

• bowel preparation
• colonoscopy
• hematochezia

AIM: To assess the diagnostic yield and clinical value of early repeat colonoscopies for indications other than colorectal cancer (CRC) screening/surveillance.

METHODS: A retrospective review of patients who had more than one colonoscopy performed for the same indication within a three year time frame at our tertiary care referral hospital between January 1, 2000 and January 1, 2010 was conducted. Exclusion criteria included repeat colonoscopies performed for CRC screening/surveillance, poor bowel preparation, suspected complications from the index procedure, and incomplete initial procedure. Primary outcome was new endoscopic finding that led to an endoscopic therapeutic intervention or any change in clinical management. Clinical parameters including age, sex, race, interval between procedures, indication of the procedure, presenting symptoms, severity of symptoms, hemodynamic instability, duration between onset of symptoms and when the procedure was performed, change in endoscopist, withdrawal time, location of colonic lesions and improvement of quality of bowel preparation were analyzed using bivariate analysis and logistic regression analysis to examine correlation with this primary outcome.

RESULTS: Among 19  772 colonoscopies performed during the above mentioned period, 947 colonoscopies (4.79%) were repeat colonoscopies performed within 3 years from the index procedure. Out of these repeat colonoscopies, 139 patient pairs met the inclusion criteria. The majority of repeat colonoscopies were for lower gastrointestinal bleeding (88.4%), change in bowel habits (6.4%) and abdominal pain (5%). Among 139 eligible patient pairs of colonoscopies, only repeat colonoscopies that were done for lower gastrointestinal bleeding and abdominal pain produced endoscopic findings that led to a change in management [25 out of 123 (20.33%) and 2 out of 7 (28.57%), respectively]. When looking at only recurrent lower gastrointestinal bleeding cases, new endoscopic findings included 8 previously undetected hemorrhoid lesions (6.5%), 7 actively bleeding lesions requiring endoscopic intervention, which included 3 bleeding arterio-venous malformations (2.43%), 2 bleeding radiation colitis (1.6%), and 2 bleeding internal hemorrhoids (1.6%), 5 previously undetected tubular adenomas [4 were smaller than 1 cm (4.9%) and 1 was larger than 1 cm (0.8%)], 3 radiation colitis (2.43%), 1 rectal ulcer (0.8%), and 1 previously undetected right sided colon cancer (0.8%). Of the 25 new endoscopic findings, 18 (72%) were found when repeat colonoscopy was done within the first year after the index procedure. These findings were 1 rectal ulcer, 3 radiation colitis, 4 new hemorrhoid lesions, 3 previously undetected tubular adenomas, and 7 actively bleeding lesions requiring endoscopic intervention. Of all parameters analyzed, only the interval between procedures less than one year was associated with higher likelihood of finding a clinically significant change in repeat colonoscopy (odds ratios of interval between procedures of 1-2 year and 2-3 year compared to 0-1 year were 0.09; 95%CI 0.01-0.74, P = 0.025 and 0.26; 95%CI 0.09-0.72, P = 0.010 respectively). No complications were observed among all 139 colonoscopy pairs.

CONCLUSION: There is clinical value of repeating a colonoscopy for recurrent lower gastrointestinal bleeding, especially within the first year after the index procedure.

• Lower gastrointestinal hemorrhage
• Recurrent hemorrhage
• Colonoscopy
• Colonic disease
• Diagnostic yield

Valid data on anemia caused by bleeding are needed for epidemiological research and monitoring health care. The Danish National Registry of Patients (DNRP) is a nationwide medical database with information on all Danish residents’ hospital history. We aimed to assess the positive predictive value (PPV) of the diagnostic coding of anemia caused by bleeding in the DNRP.

In the DNRP, we identified all patients with International Classification of Disease, 10th edition codes for anemia caused by bleeding (acute: D50.0; chronic: D62.6) at three Danish hospitals from 2000 through 2009. For these patients we computed the PPV using hemoglobin level data, from Aarhus University laboratory database, as reference standard. Anemia was defined by a hemoglobin level less than 7.0 mmol/L for women and less than 8.0 mmol/L for men.

We identified 3391 patients in the DNRP with a diagnosis of anemia caused by bleeding. The overall PPV was 95.4% (95% confidence interval [CI]: 94.6%–96.0%). The PPV was 97.6% (95% CI: 96.6%–98.3%) for men and 94.0% (95% CI: 92.9%–94.9%) for women, and the PPV increased with age at diagnosis. The PPV varied according to type of discharging departments, from 89.2% (95% CI: 83.4%–93.4%) in gynecology to 96.8% (95% CI: 94.9%–98.2%) in surgery, and was lower for outpatients compared with inpatients.

We found a high PPV of the coding for anemia caused by bleeding in the DNRP. The registry is a valid source of data on anemia caused by bleeding for various purposes including research and monitoring health care.

• Danish National Registry of Patients
• International Classification of Diseases
• anemia
• laboratory database
• predictive value
• validation

Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care.

Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy, colonoscopy, angiography, radionuclide scintigraphy and multi-detector row computed tomography. Although no modality has emerged as the gold standard in the management of LGIB, colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source. Colonoscopy has the ability to diagnose all sources of bleeding from the colon and, unlike the radiologic modalities, does not require active bleeding at the time of the examination. In addition, therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding. Studies suggest that colonoscopy, particularly when performed early in the hospitalization, can decrease hospital length of stay, rebleeding and the need for surgery. However, results from available small trials are conflicting and larger, multicenter studies are needed. Compared to other management options, colonoscopy is a safe procedure with complications reported in less than 2% of patients, including those undergoing urgent examinations. The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol), the logistical complexity of coordinating after-hours colonoscopy, and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB, particularly in urgent situations. This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

• Colonoscopy
• Acute lower gastrointestinal bleeding
• Management
• Diagnostic yield
• Therapeutic intervention
• Outcomes
• Colon preparation
• Stigmata of hemorrhage

• Endoscopic surgery

• Colonoscopy/methods
• Emergencies
• Gastrointestinal Hemorrhage/diagnosis
• Hospitalization/statistics & numerical data
• Humans
• Length of Stay/statistics & numerical data
• Randomized Controlled Trials as Topic
• Recurrence
• Risk Factors

• R01 DK084157 NIDDK NIH HHS