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Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study
The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia. METHODS: This...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560163/ https://www.ncbi.nlm.nih.gov/pubmed/34388140 http://dx.doi.org/10.14309/ajg.0000000000001413 |
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author | Nagata, Naoyoshi Kobayashi, Katsumasa Yamauchi, Atsushi Yamada, Atsuo Omori, Jun Ikeya, Takashi Aoyama, Taiki Tominaga, Naoyuki Sato, Yoshinori Kishino, Takaaki Ishii, Naoki Sawada, Tsunaki Murata, Masaki Takao, Akinari Mizukami, Kazuhiro Kinjo, Ken Fujimori, Shunji Uotani, Takahiro Fujita, Minoru Sato, Hiroki Suzuki, Sho Narasaka, Toshiaki Hayasaka, Junnosuke Funabiki, Tomohiro Kinjo, Yuzuru Mizuki, Akira Kiyotoki, Shu Mikami, Tatsuya Gushima, Ryosuke Fujii, Hiroyuki Fuyuno, Yuta Gunji, Naohiko Toya, Yosuke Narimatsu, Kazuyuki Manabe, Noriaki Nagaike, Koji Kinjo, Tetsu Sumida, Yorinobu Funakoshi, Sadahiro Kawagishi, Kana Matsuhashi, Tamotsu Komaki, Yuga Miki, Kuniko Watanabe, Kazuhiro Fukuzawa, Masakatsu Itoi, Takao Uemura, Naomi Kawai, Takashi Kaise, Mitsuru |
author_facet | Nagata, Naoyoshi Kobayashi, Katsumasa Yamauchi, Atsushi Yamada, Atsuo Omori, Jun Ikeya, Takashi Aoyama, Taiki Tominaga, Naoyuki Sato, Yoshinori Kishino, Takaaki Ishii, Naoki Sawada, Tsunaki Murata, Masaki Takao, Akinari Mizukami, Kazuhiro Kinjo, Ken Fujimori, Shunji Uotani, Takahiro Fujita, Minoru Sato, Hiroki Suzuki, Sho Narasaka, Toshiaki Hayasaka, Junnosuke Funabiki, Tomohiro Kinjo, Yuzuru Mizuki, Akira Kiyotoki, Shu Mikami, Tatsuya Gushima, Ryosuke Fujii, Hiroyuki Fuyuno, Yuta Gunji, Naohiko Toya, Yosuke Narimatsu, Kazuyuki Manabe, Noriaki Nagaike, Koji Kinjo, Tetsu Sumida, Yorinobu Funakoshi, Sadahiro Kawagishi, Kana Matsuhashi, Tamotsu Komaki, Yuga Miki, Kuniko Watanabe, Kazuhiro Fukuzawa, Masakatsu Itoi, Takao Uemura, Naomi Kawai, Takashi Kaise, Mitsuru |
author_sort | Nagata, Naoyoshi |
collection | PubMed |
description | The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia. METHODS: This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia. RESULTS: Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability. DISCUSSION: This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging. |
format | Online Article Text |
id | pubmed-8560163 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer |
record_format | MEDLINE/PubMed |
spelling | pubmed-85601632021-11-05 Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study Nagata, Naoyoshi Kobayashi, Katsumasa Yamauchi, Atsushi Yamada, Atsuo Omori, Jun Ikeya, Takashi Aoyama, Taiki Tominaga, Naoyuki Sato, Yoshinori Kishino, Takaaki Ishii, Naoki Sawada, Tsunaki Murata, Masaki Takao, Akinari Mizukami, Kazuhiro Kinjo, Ken Fujimori, Shunji Uotani, Takahiro Fujita, Minoru Sato, Hiroki Suzuki, Sho Narasaka, Toshiaki Hayasaka, Junnosuke Funabiki, Tomohiro Kinjo, Yuzuru Mizuki, Akira Kiyotoki, Shu Mikami, Tatsuya Gushima, Ryosuke Fujii, Hiroyuki Fuyuno, Yuta Gunji, Naohiko Toya, Yosuke Narimatsu, Kazuyuki Manabe, Noriaki Nagaike, Koji Kinjo, Tetsu Sumida, Yorinobu Funakoshi, Sadahiro Kawagishi, Kana Matsuhashi, Tamotsu Komaki, Yuga Miki, Kuniko Watanabe, Kazuhiro Fukuzawa, Masakatsu Itoi, Takao Uemura, Naomi Kawai, Takashi Kaise, Mitsuru Am J Gastroenterol Article The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia. METHODS: This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia. RESULTS: Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability. DISCUSSION: This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging. Wolters Kluwer 2021-11 2021-08-13 /pmc/articles/PMC8560163/ /pubmed/34388140 http://dx.doi.org/10.14309/ajg.0000000000001413 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Article Nagata, Naoyoshi Kobayashi, Katsumasa Yamauchi, Atsushi Yamada, Atsuo Omori, Jun Ikeya, Takashi Aoyama, Taiki Tominaga, Naoyuki Sato, Yoshinori Kishino, Takaaki Ishii, Naoki Sawada, Tsunaki Murata, Masaki Takao, Akinari Mizukami, Kazuhiro Kinjo, Ken Fujimori, Shunji Uotani, Takahiro Fujita, Minoru Sato, Hiroki Suzuki, Sho Narasaka, Toshiaki Hayasaka, Junnosuke Funabiki, Tomohiro Kinjo, Yuzuru Mizuki, Akira Kiyotoki, Shu Mikami, Tatsuya Gushima, Ryosuke Fujii, Hiroyuki Fuyuno, Yuta Gunji, Naohiko Toya, Yosuke Narimatsu, Kazuyuki Manabe, Noriaki Nagaike, Koji Kinjo, Tetsu Sumida, Yorinobu Funakoshi, Sadahiro Kawagishi, Kana Matsuhashi, Tamotsu Komaki, Yuga Miki, Kuniko Watanabe, Kazuhiro Fukuzawa, Masakatsu Itoi, Takao Uemura, Naomi Kawai, Takashi Kaise, Mitsuru Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title | Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title_full | Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title_fullStr | Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title_full_unstemmed | Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title_short | Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study |
title_sort | identifying bleeding etiologies by endoscopy affected outcomes in 10,342 cases with hematochezia: code blue-j study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560163/ https://www.ncbi.nlm.nih.gov/pubmed/34388140 http://dx.doi.org/10.14309/ajg.0000000000001413 |
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