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Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis
Background and Aims Lower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conf...
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Published in: | Gastrointestinal endoscopy 2017-07, Vol.86 (1), p.107-117.e1 |
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creator | Kouanda, Abdul M., MD Somsouk, Ma, MD Sewell, Justin L., MD, MPH Day, Lukejohn W., MD |
description | Background and Aims Lower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. Methods Systematic review and meta-analysis were performed on studies that compared urgent and elective colonoscopy in patients with LGIB. Pooled rates were calculated for specific outcomes, and rate ratios were determined for selected comparison groups. Results Twelve studies met inclusion criteria, with a total sample size of 10,172 patients in the urgent colonoscopy arm and 14,224 patients in the elective colonoscopy arm. Urgent colonoscopy was associated with increased use of endoscopic therapeutic intervention (RR, 1.70; 95% CI, 1.08-2.67). There were no significant differences in bleeding source localization (RR, 1.08; 95% CI, .92-1.25), adverse event rates (RR, 1.05; 95% CI, .65-1.71), rebleeding rates (RR, 1.14; 95% CI, .74-1.78), transfusion requirement (RR, 1.02; 95% CI, .73-1.41), or mortality (RR, 1.17; 95% CI, .45-3.02). Conclusions Urgent colonoscopy appears to be safe and well tolerated, but there is no clear evidence that it alters important clinical outcomes. |
doi_str_mv | 10.1016/j.gie.2017.01.035 |
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Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. Methods Systematic review and meta-analysis were performed on studies that compared urgent and elective colonoscopy in patients with LGIB. Pooled rates were calculated for specific outcomes, and rate ratios were determined for selected comparison groups. Results Twelve studies met inclusion criteria, with a total sample size of 10,172 patients in the urgent colonoscopy arm and 14,224 patients in the elective colonoscopy arm. Urgent colonoscopy was associated with increased use of endoscopic therapeutic intervention (RR, 1.70; 95% CI, 1.08-2.67). There were no significant differences in bleeding source localization (RR, 1.08; 95% CI, .92-1.25), adverse event rates (RR, 1.05; 95% CI, .65-1.71), rebleeding rates (RR, 1.14; 95% CI, .74-1.78), transfusion requirement (RR, 1.02; 95% CI, .73-1.41), or mortality (RR, 1.17; 95% CI, .45-3.02). Conclusions Urgent colonoscopy appears to be safe and well tolerated, but there is no clear evidence that it alters important clinical outcomes.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2017.01.035</identifier><identifier>PMID: 28174123</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Blood Transfusion ; Colonoscopy - adverse effects ; Elective Surgical Procedures ; Emergencies ; Gastroenterology and Hepatology ; Gastrointestinal Hemorrhage - diagnostic imaging ; Gastrointestinal Hemorrhage - mortality ; Gastrointestinal Hemorrhage - therapy ; Humans ; Length of Stay - economics ; Recurrence</subject><ispartof>Gastrointestinal endoscopy, 2017-07, Vol.86 (1), p.107-117.e1</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2017 American Society for Gastrointestinal Endoscopy</rights><rights>Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-df905d99c98cbad6a68ac9c49d85f55ef8ad9ff8490b8e608a7bc2dcce2b7f3b3</citedby><cites>FETCH-LOGICAL-c408t-df905d99c98cbad6a68ac9c49d85f55ef8ad9ff8490b8e608a7bc2dcce2b7f3b3</cites><orcidid>0000-0002-7332-1898</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28174123$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kouanda, Abdul M., MD</creatorcontrib><creatorcontrib>Somsouk, Ma, MD</creatorcontrib><creatorcontrib>Sewell, Justin L., MD, MPH</creatorcontrib><creatorcontrib>Day, Lukejohn W., MD</creatorcontrib><title>Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background and Aims Lower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. Methods Systematic review and meta-analysis were performed on studies that compared urgent and elective colonoscopy in patients with LGIB. Pooled rates were calculated for specific outcomes, and rate ratios were determined for selected comparison groups. Results Twelve studies met inclusion criteria, with a total sample size of 10,172 patients in the urgent colonoscopy arm and 14,224 patients in the elective colonoscopy arm. Urgent colonoscopy was associated with increased use of endoscopic therapeutic intervention (RR, 1.70; 95% CI, 1.08-2.67). There were no significant differences in bleeding source localization (RR, 1.08; 95% CI, .92-1.25), adverse event rates (RR, 1.05; 95% CI, .65-1.71), rebleeding rates (RR, 1.14; 95% CI, .74-1.78), transfusion requirement (RR, 1.02; 95% CI, .73-1.41), or mortality (RR, 1.17; 95% CI, .45-3.02). Conclusions Urgent colonoscopy appears to be safe and well tolerated, but there is no clear evidence that it alters important clinical outcomes.</description><subject>Blood Transfusion</subject><subject>Colonoscopy - adverse effects</subject><subject>Elective Surgical Procedures</subject><subject>Emergencies</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastrointestinal Hemorrhage - diagnostic imaging</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Humans</subject><subject>Length of Stay - economics</subject><subject>Recurrence</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kcGKFDEQhoMo7uzqA3iRHL10W0mmO4mCsCy6Lix40D1KSCfVY8buzpj0OPTb-Cw-2WaY1YMHTwXF9_9QXxHygkHNgLWvt_UmYM2ByRpYDaJ5RFYMtKxaKfVjsoICVQ0DeUbOc94CgOKCPSVnXDG5ZlysyNe7tMFppi4OcYrZxd1Cw0R3dg5lnekhzN_oEA-Y6PUN7QZEH6bNG2p__8pLnnEsoKMJfwY8UDt5OuJsKzvZYckhPyNPejtkfP4wL8jdh_dfrj5Wt5-ub64ubyu3BjVXvtfQeK2dVq6zvrWtsk67tfaq6ZsGe2W97nu11tApbEFZ2TnunUPeyV504oK8OvXuUvyxxzybMWSHw2AnjPtsmGpbrkUrREHZCXUp5pywN7sURpsWw8AcrZqtKVbN0aoBZorVknn5UL_vRvR_E380FuDtCcByZFGRTHbFnyuyErrZ-Bj-W__un7QbwhScHb7jgnkb96n4LFeYzA2Yz8e3Hr_KpACQmot7SqufYQ</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Kouanda, Abdul M., MD</creator><creator>Somsouk, Ma, MD</creator><creator>Sewell, Justin L., MD, MPH</creator><creator>Day, Lukejohn W., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7332-1898</orcidid></search><sort><creationdate>20170701</creationdate><title>Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis</title><author>Kouanda, Abdul M., MD ; Somsouk, Ma, MD ; Sewell, Justin L., MD, MPH ; Day, Lukejohn W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-df905d99c98cbad6a68ac9c49d85f55ef8ad9ff8490b8e608a7bc2dcce2b7f3b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Blood Transfusion</topic><topic>Colonoscopy - adverse effects</topic><topic>Elective Surgical Procedures</topic><topic>Emergencies</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastrointestinal Hemorrhage - diagnostic imaging</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Humans</topic><topic>Length of Stay - economics</topic><topic>Recurrence</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kouanda, Abdul M., MD</creatorcontrib><creatorcontrib>Somsouk, Ma, MD</creatorcontrib><creatorcontrib>Sewell, Justin L., MD, MPH</creatorcontrib><creatorcontrib>Day, Lukejohn W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kouanda, Abdul M., MD</au><au>Somsouk, Ma, MD</au><au>Sewell, Justin L., MD, MPH</au><au>Day, Lukejohn W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>86</volume><issue>1</issue><spage>107</spage><epage>117.e1</epage><pages>107-117.e1</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Background and Aims Lower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. Methods Systematic review and meta-analysis were performed on studies that compared urgent and elective colonoscopy in patients with LGIB. Pooled rates were calculated for specific outcomes, and rate ratios were determined for selected comparison groups. Results Twelve studies met inclusion criteria, with a total sample size of 10,172 patients in the urgent colonoscopy arm and 14,224 patients in the elective colonoscopy arm. Urgent colonoscopy was associated with increased use of endoscopic therapeutic intervention (RR, 1.70; 95% CI, 1.08-2.67). There were no significant differences in bleeding source localization (RR, 1.08; 95% CI, .92-1.25), adverse event rates (RR, 1.05; 95% CI, .65-1.71), rebleeding rates (RR, 1.14; 95% CI, .74-1.78), transfusion requirement (RR, 1.02; 95% CI, .73-1.41), or mortality (RR, 1.17; 95% CI, .45-3.02). Conclusions Urgent colonoscopy appears to be safe and well tolerated, but there is no clear evidence that it alters important clinical outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28174123</pmid><doi>10.1016/j.gie.2017.01.035</doi><orcidid>https://orcid.org/0000-0002-7332-1898</orcidid></addata></record> |
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subjects | Blood Transfusion Colonoscopy - adverse effects Elective Surgical Procedures Emergencies Gastroenterology and Hepatology Gastrointestinal Hemorrhage - diagnostic imaging Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - therapy Humans Length of Stay - economics Recurrence |
title | Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis |
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