Early colonoscopy did not improve outcomes in those hospitalized for lower GI bleeding

A meta-analysis included four randomized trials comparing outcomes of colonoscopy within 24 hours versus later elective colonoscopy and/or other diagnostic tests in patients with lower gastrointestinal (GI) bleeding.

Early colonoscopy (i.e., within 24 hours) did not improve outcomes among patients hospitalized with lower gastrointestinal (GI) bleeding, according to a new meta-analysis.

The analysis included four randomized trials that compared early colonoscopy to later elective colonoscopy and/or other diagnostic tests in patients hospitalized with acute lower GI bleeding or hematochezia. The primary outcome was further bleeding, either persistent or recurrent after examination. Secondary outcomes included mortality, diagnostic yield (identifying source of bleeding), endoscopic intervention, and any primary hemostatic intervention (by endoscopy, surgery, or interventional radiology). Results were published by Clinical Gastroenterology and Hepatology on Dec. 13.

The results showed that risk of further bleeding was not reduced with early colonoscopy and, in fact, showed a trend toward an increase (relative risk [RR], 1.57; 95% CI, 0.74 to 3.31). There were also no significant differences between the groups in rates of mortality (RR, 0.93; 95% CI, 0.05 to 17.21), diagnostic yield (RR, 1.09; 95% CI, 0.99 to 1.21), endoscopic intervention (RR, 1.53; 95% CI, 0.67 to 3.48), or any primary hemostatic intervention (RR, 1.33; 95% CI, 0.92 to 1.92).

Prior reviews and an observational cohort study found a similar lack of benefit on bleeding with early colonoscopy, the study authors said. “Our results should be incorporated by future guideline panels. Current U.S. guidelines suggest early colonoscopy in patients with severe hematochezia or those with high-risk clinical features and ongoing bleeding,” they wrote. The meta-analysis did not specifically assess this subgroup, but by focusing on hospital patients, the included studies had substantial numbers of patients with higher-risk or more severe bleeding, the authors said.

They noted several limitations of the meta-analysis, including that it only had four studies, two of which were terminated prematurely. Despite the limitations, the authors believe that the results have implications for clinical practice. “Although early colonoscopy within 24 hours is generally safe it does not improve clinically important outcomes in patients hospitalized with LGIB [lower GI bleeding]. Elective colonoscopy performed 24 hours or more after presentation is appropriate for most patients hospitalized with acute LGIB,” they advised.