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Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?

Background and study aims  We evaluated the utility of esophagogastroduodenoscopy (EGD) or capsule endoscopy (CE) as the next diagnostic approach after negative colonoscopy (CS) results in acute-onset hematochezia. Patients and methods  We retrospectively analyzed 401 patients emergently hospitalize...

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Autores principales: Aoki, Tomonori, Nagata, Naoyoshi, Yamada, Atsuo, Shimbo, Takuro, Matsushita, Yuuki, Shimomura, Akira, Kobayashi, Sakurako, Moriyasu, Shiori, Niikura, Ryota, Sakurai, Toshiyuki, Hirata, Yoshihiro, Akiyama, Junichi, Uemura, Naomi, Koike, Kazuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2019
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395095/
https://www.ncbi.nlm.nih.gov/pubmed/30834292
http://dx.doi.org/10.1055/a-0824-6647
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author Aoki, Tomonori
Nagata, Naoyoshi
Yamada, Atsuo
Shimbo, Takuro
Matsushita, Yuuki
Shimomura, Akira
Kobayashi, Sakurako
Moriyasu, Shiori
Niikura, Ryota
Sakurai, Toshiyuki
Hirata, Yoshihiro
Akiyama, Junichi
Uemura, Naomi
Koike, Kazuhiko
author_facet Aoki, Tomonori
Nagata, Naoyoshi
Yamada, Atsuo
Shimbo, Takuro
Matsushita, Yuuki
Shimomura, Akira
Kobayashi, Sakurako
Moriyasu, Shiori
Niikura, Ryota
Sakurai, Toshiyuki
Hirata, Yoshihiro
Akiyama, Junichi
Uemura, Naomi
Koike, Kazuhiko
author_sort Aoki, Tomonori
collection PubMed
description Background and study aims  We evaluated the utility of esophagogastroduodenoscopy (EGD) or capsule endoscopy (CE) as the next diagnostic approach after negative colonoscopy (CS) results in acute-onset hematochezia. Patients and methods  We retrospectively analyzed 401 patients emergently hospitalized for acute hematochezia who underwent CS within 48 hours of arriving at two large emergency hospitals and in whom a definitive bleeding source was not identified. The positive endoscopic findings, requirement for additional therapeutic procedures, and 30-day rebleeding rates were compared among three strategies: EGD following CS (CS-EGD), CE following CS (CS-CE), and CS alone. Predictors of positive endoscopic findings in the CS-EGD strategy were determined. Results  The rates of positive endoscopic findings and requirement for additional therapeutic procedures were 22 % and 16 %, respectively, in CS-EGD and 50 % and 28 % in CS-CE. The 30-day rebleeding rate did not significantly decrease in CS-EGD (8 %) or CS-CE (11 %) compared with CS alone (12 %). The rate of additional endoscopic therapies was lower in patients with a colonic diverticulum than in those without (CS-EGD: 3 % vs. 33 %, P  = 0.007; CS-CE: 11 % vs. 44 %, P  = 0.147). A history of syncope, low blood pressure, blood urea nitrogen/creatinine ratio of ≥ 30, and low albumin level significantly predicted EGD findings after negative CS results ( P  < 0.05). Conclusions  When the definitive bleeding source is not identified by colonoscopy in patients with acute hematochezia, adjunctive endoscopy helps to identify the etiology and enables subsequent therapy, especially for patients without a colonic diverticulum. Upper gastrointestinal endoscopy is indicated for severe bleeding; other patients may be candidates for capsule endoscopy.
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spelling pubmed-63950952019-03-05 Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy? Aoki, Tomonori Nagata, Naoyoshi Yamada, Atsuo Shimbo, Takuro Matsushita, Yuuki Shimomura, Akira Kobayashi, Sakurako Moriyasu, Shiori Niikura, Ryota Sakurai, Toshiyuki Hirata, Yoshihiro Akiyama, Junichi Uemura, Naomi Koike, Kazuhiko Endosc Int Open Background and study aims  We evaluated the utility of esophagogastroduodenoscopy (EGD) or capsule endoscopy (CE) as the next diagnostic approach after negative colonoscopy (CS) results in acute-onset hematochezia. Patients and methods  We retrospectively analyzed 401 patients emergently hospitalized for acute hematochezia who underwent CS within 48 hours of arriving at two large emergency hospitals and in whom a definitive bleeding source was not identified. The positive endoscopic findings, requirement for additional therapeutic procedures, and 30-day rebleeding rates were compared among three strategies: EGD following CS (CS-EGD), CE following CS (CS-CE), and CS alone. Predictors of positive endoscopic findings in the CS-EGD strategy were determined. Results  The rates of positive endoscopic findings and requirement for additional therapeutic procedures were 22 % and 16 %, respectively, in CS-EGD and 50 % and 28 % in CS-CE. The 30-day rebleeding rate did not significantly decrease in CS-EGD (8 %) or CS-CE (11 %) compared with CS alone (12 %). The rate of additional endoscopic therapies was lower in patients with a colonic diverticulum than in those without (CS-EGD: 3 % vs. 33 %, P  = 0.007; CS-CE: 11 % vs. 44 %, P  = 0.147). A history of syncope, low blood pressure, blood urea nitrogen/creatinine ratio of ≥ 30, and low albumin level significantly predicted EGD findings after negative CS results ( P  < 0.05). Conclusions  When the definitive bleeding source is not identified by colonoscopy in patients with acute hematochezia, adjunctive endoscopy helps to identify the etiology and enables subsequent therapy, especially for patients without a colonic diverticulum. Upper gastrointestinal endoscopy is indicated for severe bleeding; other patients may be candidates for capsule endoscopy. © Georg Thieme Verlag KG 2019-03 2019-02-28 /pmc/articles/PMC6395095/ /pubmed/30834292 http://dx.doi.org/10.1055/a-0824-6647 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Aoki, Tomonori
Nagata, Naoyoshi
Yamada, Atsuo
Shimbo, Takuro
Matsushita, Yuuki
Shimomura, Akira
Kobayashi, Sakurako
Moriyasu, Shiori
Niikura, Ryota
Sakurai, Toshiyuki
Hirata, Yoshihiro
Akiyama, Junichi
Uemura, Naomi
Koike, Kazuhiko
Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title_full Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title_fullStr Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title_full_unstemmed Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title_short Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
title_sort next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy?
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395095/
https://www.ncbi.nlm.nih.gov/pubmed/30834292
http://dx.doi.org/10.1055/a-0824-6647
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