Aim: Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non-endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy.
Methods: We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in-hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score-matched analyses were undertaken to adjust for confounders.
Results: We identified 6,546 eligible patients. The patients were divided into the colonoscopy group ( = 5,737) and angiography group ( = 809). After one-to-four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in-hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group.
Conclusions: The present study revealed that in-hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.
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http://dx.doi.org/10.1002/ams2.533 | DOI Listing |
Cureus
December 2024
Department of Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR.
Lower gastrointestinal bleeding (LGIB) is a common clinical condition typically associated with diseases like diverticular disease, inflammatory bowel disease, and cancer. However, rarer etiologies such as appendiceal hemorrhage can present similarly, complicating diagnosis and management. This case report discusses a 42-year-old male who presented with severe rectal bleeding.
View Article and Find Full Text PDFEur Radiol
October 2024
Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 10117, Berlin, Germany.
Purpose: To assess the technical feasibility, safety, and clinical success rate of trans-arterial embolization (TAE) as an emergency treatment for acute lower gastrointestinal bleeding (LGIB).
Materials And Methods: Consecutive patients who received urgent TAE due to active LGIB at five academic centers in Germany were retrospectively analyzed. LGIB was confirmed and localized using contrast-enhanced computed tomography (CT) or endoscopy.
Cureus
August 2024
Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Guidelines for managing lower gastrointestinal bleeding (LGIB) can vary significantly, posing challenges in clinical settings. This case involves a previously healthy man who presented with severe acute rectal bleeding, along with COVID-19 positivity, Janeway lesions, and splinter hemorrhages. His condition rapidly deteriorated, with evidence suggesting a diverticular bleed.
View Article and Find Full Text PDFWorld J Surg
February 2024
Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Hatyai, Songkhla, Thailand.
Background: This study aimed to determine the performance of the Oakland, Glasgow-Blatchford, and AIMS65 scores in predicting the clinical outcomes of acute lower gastrointestinal bleeding (LGIB).
Methods: This prospective cohort study was conducted from July 2020 to July 2021. Patients admitted with acute lower gastrointestinal bleeding were enrolled.
Am J Emerg Med
July 2024
Department of Emergency Medicine Rush, University Medical Center, Chicago, IL, USA.
Introduction: Lower gastrointestinal bleeding (LGIB) is a condition commonly seen in the emergency department. Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
Objective: This paper evaluates key evidence-based updates concerning LGIB for the emergency clinician.
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