Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study

Area of Science:

• Gastroenterology
• Internal Medicine
• Diagnostic Imaging

Background:

• Hematochezia diagnosis often requires invasive procedures.
• Identifying the source of lower gastrointestinal bleeding is critical for patient management.
• Colonoscopy is a key tool, but its role in risk stratification needs further clarification.

Purpose of the Study:

• To determine if colonoscopy can stratify risk and predict outcomes in hematochezia patients.
• To assess if presenting symptoms can differentiate bleeding etiologies.
• To analyze the diagnostic yield and therapeutic implications of colonoscopy for hematochezia.

Main Methods:

• A multicenter retrospective cohort study involving 10,342 patients with acute hematochezia across 49 Japanese hospitals.
• Analysis of data including computed tomography (CT) and colonoscopy findings.
• Correlation of presenting symptoms with bleeding etiologies and patient outcomes.

Main Results:

• Colonoscopy achieved a 94.9% diagnostic yield, with diverticular bleeding being most frequent.
• Higher rebleeding rates were observed in diverticulosis and small bowel bleeding.
• In-hospital mortality was elevated with angioectasia, malignancy, rectal ulcer, and upper GI bleeding.
• Colonoscopic treatment was more frequent for diverticulosis, radiation colitis, and angioectasia.
• Painless hematochezia correlated with conditions like rectal ulcer, hemorrhoids, and diverticulosis.

Conclusions:

• Colonoscopy is essential for accurate hematochezia etiology detection and patient risk stratification.
• It helps predict adverse outcomes and the need for further procedures.
• Predicting bleeding etiologies solely on initial presentation is challenging.