TY - JOUR
T1 - Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia
T2 - CODE BLUE-J Study
AU - Nagata, Naoyoshi
AU - Kobayashi, Katsumasa
AU - Yamauchi, Atsushi
AU - Yamada, Atsuo
AU - Omori, Jun
AU - Ikeya, Takashi
AU - Aoyama, Taiki
AU - Tominaga, Naoyuki
AU - Sato, Yoshinori
AU - Kishino, Takaaki
AU - Ishii, Naoki
AU - Sawada, Tsunaki
AU - Murata, Masaki
AU - Takao, Akinari
AU - Mizukami, Kazuhiro
AU - Kinjo, Ken
AU - Fujimori, Shunji
AU - Uotani, Takahiro
AU - Fujita, Minoru
AU - Sato, Hiroki
AU - Suzuki, Sho
AU - Narasaka, Toshiaki
AU - Hayasaka, Junnosuke
AU - Funabiki, Tomohiro
AU - Kinjo, Yuzuru
AU - Mizuki, Akira
AU - Kiyotoki, Shu
AU - Mikami, Tatsuya
AU - Gushima, Ryosuke
AU - Fujii, Hiroyuki
AU - Fuyuno, Yuta
AU - Gunji, Naohiko
AU - Toya, Yosuke
AU - Narimatsu, Kazuyuki
AU - Manabe, Noriaki
AU - Nagaike, Koji
AU - Kinjo, Tetsu
AU - Sumida, Yorinobu
AU - Funakoshi, Sadahiro
AU - Kawagishi, Kana
AU - Matsuhashi, Tamotsu
AU - Komaki, Yuga
AU - Miki, Kuniko
AU - Watanabe, Kazuhiro
AU - Fukuzawa, Masakatsu
AU - Itoi, Takao
AU - Uemura, Naomi
AU - Kawai, Takashi
AU - Kaise, Mitsuru
N1 - Funding Information:
Financial support: This work was partially supported by grants from the Ministry of Health, Labour and Welfare, Japan (grant number: 19HB1003), JSPS KAKENHI grant (JP17K09365 and 20K08366), Smoking Research Foundation, Takeda Science Foundation, Tokyo Medical University Cancer Research Foundation, Tokyo Medical University Research Foundation, Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, and 30-1020). The funders played no role in the study design, analysis, and decision to publish the manuscript.
Publisher Copyright:
© 2021 Wolters Kluwer Health. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - INTRODUCTION: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.
AB - INTRODUCTION: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.
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U2 - 10.14309/ajg.0000000000001413
DO - 10.14309/ajg.0000000000001413
M3 - Article
C2 - 34388140
AN - SCOPUS:85117363645
SN - 0002-9270
VL - 116
SP - 2222
EP - 2234
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 11
ER -
