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Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational
Yasuhiko Miyakuni1, Mikio Nakajima2,3, Hiroyuki Ohbe3
1Department of Trauma and Critical Care Medicine School of Medicine Kyorin University Tokyo Japan.
Insights
For severe lower gastrointestinal bleeding (LGIB), angiography did not reduce in-hospital mortality compared to colonoscopy. However, angiography led to fewer early surgeries, suggesting it may be preferable for initial treatment in critical LGIB cases.
Area of Science:
- Gastroenterology
- Interventional Radiology
Background:
- Clinical guidelines suggest non-endoscopic treatment for acute lower gastrointestinal bleeding (LGIB) when colonoscopy is challenging or patients are unstable.
- The optimal initial treatment strategy for severe LGIB remains debated.
Purpose of the Study:
- To compare the effectiveness of angiography versus colonoscopy as initial treatment for severe LGIB.
- To determine if angiography should be prioritized over colonoscopy for severe LGIB patients.
Main Methods:
- Retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database (2010-2017).
- Comparison of adult patients with severe LGIB undergoing colonoscopy or angiography within 1 day of admission.
- Propensity score-matched analysis to adjust for confounders, focusing on in-hospital mortality and early surgery rates.
Main Results:
- In-hospital mortality was not significantly different between the angiography and colonoscopy groups.
- Angiography was associated with a significantly lower rate of surgery within 1 day of admission compared to colonoscopy.
- No significant difference in surgery rates between 2 and 7 days post-admission was observed.
Conclusions:
- Neither colonoscopy nor angiography significantly impacted in-hospital mortality for severe LGIB patients.
- Angiography may be a more suitable initial treatment option than colonoscopy for severe LGIB, particularly regarding the reduction of early surgical intervention.
- Further research is needed to identify specific subgroups that would benefit most from primary angiography for hemostasis.
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 (n = 5,737) and angiography group (n = 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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