Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding
Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding
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DOI：
10.1053/j.gastro.2019.09.010
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发表时间：
2020-01-01
期刊：
影响因子：
29.4
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
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作者：
Niikura, Ryota;Nagata, Naoyoshi;Koike, Kazuhiko
背景与目的：我们进行了一项大型、多中心、随机对照试验，以确定早期结肠镜检查对急性下消化道出血(ALGIB)患者预后的有效性和安全性。方法：我们在日本15家医院进行了一项开放标签研究，170名ALGIB患者随机(1：1)分为早期结肠镜检查组(首次就诊后24小时内)或选择性结肠镜检查组(入院后24-96小时)。主要结果是确定近期出血的斑点(SRH)。次要结果是30天内再次出血，内窥镜治疗成功，需要输血，住院时间，30天内血栓事件，30天内死亡，以及不良事件。结果：早期结肠镜组79例患者中有17例(21.5%)发现SRH，而择期结肠镜组有17例患者(21.3%)(差值0.3；95%可信区间-12.5~13.0；P=.967)。早期结肠镜组和择期结肠镜组分别有15.3%和6.7%的患者在入院后30天内再次出血(差值8.6；95%可信区间-1.4~18.7)；两组在内窥镜治疗成功率、输血率、住院时间、血栓事件和30天内死亡方面无显著差异。早期组无一例患者在肠道准备过程中发生失血性休克的不良事件，而择期结肠镜组有2例患者(2.5%)。结论：在一项随机对照研究中，我们发现，与24-96小时的结肠镜检查相比，在ALGIB患者入院后24小时内进行结肠镜检查并没有增加SRH或减少再出血。
BACKGROUND & AIMS: We performed a large, multicenter, randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower gastrointestinal bleeding (ALGIB). METHODS: We performed an open-label study at 15 hospitals in Japan of 170 patients with ALGIB randomly assigned (1:1) to groups that underwent early colonoscopy (within 24 hours of initial visit to the hospital) or elective colonoscopy (24-96 hours after hospital admission). The primary outcome was identification of stigmata of recent hemorrhage (SRH). Secondary outcomes were rebleeding within 30 days, endoscopic treatment success, need for transfusion, length of stay, thrombotic events within 30 days, death within 30 days, and adverse events. RESULTS: SRH were identified in 17 of 79 patients (21.5%) in the early colonoscopy group vs 17 of 80 patients (21.3%) in the elective colonoscopy group (difference, 0.3; 95% confidence interval, -12.5 to 13.0; P = .967). Rebleeding within 30 days of hospital admission occurred in 15.3% of patients in the early colonoscopy group and 6.7% of patients in the elective colonoscopy group (difference, 8.6; 95% confidence interval, -1.4 to 18.7); there were no significant differences between groups in successful endoscopic treatment rate, transfusion rate, length of stay, thrombotic events, or death within 30 days. The adverse event of hemorrhagic shock occurred during bowel preparation in no patient in the early group vs 2 patients (2.5%) in the elective colonoscopy group. CONCLUSIONS: In a randomized controlled study, we found that colonoscopy within 24 hours after hospital admission did not increase SRH or reduce rebleeding compared with colonoscopy at 24-96 hours in patients with ALGIB.