Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding

The American Journal of Gastroenterology
Loren Laine, Abbid Shah

Abstract

We sought to determine, in patients with serious hematochezia, the proportion who have an upper gastrointestinal (GI) source and whether urgent colonoscopy improves outcomes as compared with elective colonoscopy in those without an upper source. Patients with hematochezia were eligible if they also had heart rate >100, systolic blood pressure <100, orthostatic change in heart rate or blood pressure >20, hemoglobin drop ≥ 1.5 g/dl, or blood transfusion. Patients had upper endoscopy within 6 h. Those without an upper source were randomized to urgent (≤ 12 h) or elective (36-60 h after presentation) colonoscopy. The primary end point was further bleeding. Patients were followed for the duration of hospitalization. Eighty-five eligible patients had urgent upper endoscopy; 13 (15%) had an upper source. The remaining 72 were randomized to urgent (N=36) or elective (N=36) colonoscopy. Further bleeding occurred in 8 (22%) vs. 5 (14%) of the urgent vs. elective groups (difference=8%, 95% confidence interval (CI)=-9 to 26%). Units of blood (1.5 vs. 0.7), hospital days (5.2 vs. 4.8), subsequent diagnostic or therapeutic interventions for bleeding (36% vs. 33%), and hospital charges ($27,590 vs. $26,633) also were not lower in the urgent g...Continue Reading

References

Jul 1, 1990·Archives of Internal Medicine·R E CuellarD H Van Thiel
Apr 16, 2003·Archives of Internal Medicine·Lisa L StrateSapna Syngal
Jun 8, 2004·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Fernando S VelayosJonathan P Terdiman
Oct 26, 2005·Gastrointestinal Endoscopy·Raquel E DavilaUNKNOWN Standards of Practice Committee
Nov 24, 2005·Gastroenterology Clinics of North America·Lisa L Strate
Nov 24, 2005·Gastroenterology Clinics of North America·Bryan T Green, Don C Rockey
Jul 4, 2009·The American Journal of Gastroenterology·Angel LanasSantiago Garcia
Dec 29, 2009·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Lisa L Strate, Christopher R Naumann

❮ Previous
Next ❯

Citations

Nov 13, 2012·Annals of Intensive Care·David OsmanUNKNOWN group of experts
Apr 3, 2012·World Journal of Gastroenterology : WJG·Dekey Y Lhewa, Lisa L Strate
Jun 25, 2014·Gastroenterology Report·Mazen AlbeldawiJohn J Vargo
Dec 31, 2014·Gastroenterology Research and Practice·Tarun Rustagi, Thomas R McCarty
Oct 12, 2015·International Journal of Colorectal Disease·Andrew J MossArshad Malik
Mar 2, 2016·The American Journal of Gastroenterology·Lisa L Strate, Ian M Gralnek
Jun 16, 2016·AJR. American Journal of Roentgenology·Joseph D FeuersteinDaniel A Leffler
Mar 16, 2017·The New England Journal of Medicine·Ian M GralnekLisa L Strate
Feb 9, 2017·Gastrointestinal Endoscopy·Abdul M KouandaLukejohn W Day
Apr 29, 2014·Journal of Visceral Surgery·Y MarionA Alves
Apr 8, 2014·Gastrointestinal Endoscopy·Shabana F PashaBrooks D Cash
Dec 7, 2010·The American Journal of Gastroenterology·Lisa L Strate
Feb 9, 2012·The American Journal of Gastroenterology·Loren Laine, Dennis M Jensen
Jan 23, 2018·Journal of Clinical Gastroenterology·Toshihisa IchibaReiji Higashi
Jun 6, 2013·The American Journal of Gastroenterology·Joshua D PenfieldTodd H Baron
Jan 13, 2019·Journal of Gastroenterology and Hepatology·Michiko WadaTakanori Kanai
Dec 7, 2010·The American Journal of Gastroenterology·Bénédicte De VroeyJean-Frédéric Colombel
Dec 8, 2017·Diseases of the Colon and Rectum·Stephen R SmithRosemary Carroll
Aug 11, 2015·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Atsuo YamadaKazuhiko Koike
Oct 31, 2013·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Shotaro NakamuraMakoto Hashizume
Feb 1, 2020·Journal of Gastroenterology and Hepatology·Rajat GargMiguel Regueiro
Jul 29, 2016·Journal of Clinical Gastroenterology·Neil SenguptaJoseph D Feuerstein
Jun 12, 2016·Digestive Diseases and Sciences·Marine CamusGareth S Dulai
Jul 19, 2019·Gut·John S LeedsDavid S Sanders
Aug 10, 2019·Gut·Kathryn Oakland, Jonathan Hoare
Aug 26, 2017·Frontline Gastroenterology·John FrostSauid Ishaq
Oct 24, 2017·Current Opinion in Gastroenterology·Jason D EckmannConor G Loftus
Jan 16, 2019·World Journal of Gastroenterology : WJG·Tomonori AokiKazuhiko Koike
Oct 28, 2019·Frontline Gastroenterology·Ashley Bond, Philip J Smith
Jul 5, 2018·JAMA : the Journal of the American Medical Association·Neil Sengupta, Adam S Cifu
Aug 24, 2018·Digestive Diseases and Sciences·Salmaan JawaidDavid Cave
Dec 31, 2014·World Journal of Gastroenterology : WJG·Adolfo Parra-BlancoTakahiro Fujii
Jan 11, 2017·World Journal of Emergency Surgery : WJES·Daniel ClercMartin Hübner

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.