Validation of British Society of Gastroenterology guidelines for acute lower gastrointestinal bleeding from 8,956 cases in Japan

• Published in: Gastrointestinal endoscopy 2024-11
• Main Authors: Kinjo, Ken, Aoki, Tomonori, 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, 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, Hikichi, Takuto, Toya, Yosuke, Narimatsu, Kazuyuki, Manabe, Noriaki, Nagaike, Koji, Kinjo, Tetsu, Sumida, Yorinobu, Funakoshi, Sadahiro, Kobayashi, Kiyonori, Matsuhashi, Tamotsu, Komaki, Yuga, Watanabe, Kazuhiro, Hisabe, Takashi, Yao, Kenshi, Kaise, Mitsuru, Nagata, Naoyoshi
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2024.11.020

We sought to validate the British Society of Gastroenterology (BSG) guidelines for acute lower gastrointestinal bleeding (ALGIB). We analyzed 8,956 patients with ALGIB in CODE BLUE-J study and categorized them into four groups based on BSG guidelines. Outcomes included 30-day rebleeding, 30-day mortality, blood transfusion, therapeutic intervention, and severe bleeding. The severe bleeding rates significantly decreased from Group I to IV: 92.1%, 70.1%, 58.7%, and 38.4%. The rate of the need for blood transfusion and 30-day mortality also decreased from I to IV. Although outpatient follow-up was recommended in Group IV, it had high rates of severe bleeding (38%) and 30-day rebleeding (11%). Notably, for colonic diverticular bleeding, the rate of 30-day rebleeding was 25.5%, even with an Oakland score ≤ 8. We identified abdominal pain, diarrhea, and a high white blood cell count as independent factors that differentiate between non-severe and severe bleeding cases in Group IV. Using these factors, the 30-day rebleeding rate in the non-severe group was 3.6%, suggesting the feasibility of outpatient follow-up in this group. Furthermore, a novel, Group X, which deviated from the existing four groups, had a high severe bleeding rate (70.9%) comparable to that of Group II. The BSG guidelines suggest a management approach that can clearly differentiate severity. However, caution is advised when using the Oakland score to triage patients for outpatient follow-up. Additionally, prompt intervention may be necessary for groups not covered by the guidelines.