Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding

Alimentary Pharmacology & Therapeutics
Omar KheradAlan N Barkun

Abstract

The optimal timing of colonoscopy in acute lower gastrointestinal bleeding (LGIB) remains controversial. To characterise the utility of early colonoscopy (within 24 hours) in managing acute LGIB. A systematic literature search to October 2019 identified fully published articles and abstracts of randomised controlled trials (RCTs) and observational studies with control groups assessing early colonoscopy in acute LGIB. The primary outcome was rebleeding. Secondary outcomes included mortality, surgery, length of stay (LOS), definite cause of bleeding and adverse events. Odds ratios (ORs) and mean differences (MD) were calculated. Of 1116 citations, 4 RCTs (466 patients) and 13 observational studies with elective colonoscopy (>24 hours) as control group (1 061 281 patients) were included. No differences in rebleeding were noted between early and elective colonoscopy groups among RCTs alone (OR = 1.70; 0.79; 3.64), or observational studies alone (OR = 1.20; 0.69; 2.09). No other significant between-group differences in outcomes were found when restricting the analysis to RCTs. Among observational studies only, early colonoscopy was associated with lower rates of all-cause mortality (OR = 0.86; 0.75; 0.98), surgery (OR = 0.52; 0.42; ...Continue Reading

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