TY - JOUR
T1 - High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding
T2 - a nationwide study in Japan
AU - CODE BLUE-J Study collaborators
AU - Aoki, Tomonori
AU - Sadashima, Eiji
AU - Kobayashi, Katsumasa
AU - Yamauchi, Atsushi
AU - Yamada, Atsuo
AU - Omori, Jun
AU - Ikeya, Takashi
AU - Aoyama, Taiki
AU - Tominaga, Naoyuki
AU - Sato, Yoshinori
AU - Kishino, Takaaki
AU - Ishii, Naoki
AU - Sawada, Tsunaki
AU - Murata, Masaki
AU - Takao, Akinari
AU - Mizukami, Kazuhiro
AU - Kinjo, Ken
AU - Fujimori, Shunji
AU - Uotani, Takahiro
AU - Fujita, Minoru
AU - Sato, Hiroki
AU - Hayakawa, Yoku
AU - Fujishiro, Mitsuhiro
AU - Kaise, Mitsuru
AU - Nagata, Naoyoshi
AU - Suzuki, Sho
AU - Narasaka, Toshiaki
AU - Hayasaka, Junnosuke
AU - Funabiki, Tomohiro
AU - Kinjo, Yuzuru
AU - Mizuki, Akira
AU - Kiyotoki, Shu
AU - Mikami, Tatsuya
AU - Gushima, Ryosuke
AU - Fujii, Hiroyuki
AU - Fuyuno, Yuta
AU - Hikichi, Takuto
AU - Toya, Yosuke
AU - Narimatsu, Kazuyuki
AU - Manabe, Noriaki
AU - Nagaike, Koji
AU - Kinjo, Tetsu
AU - Sumida, Yorinobu
AU - Funakoshi, Sadahiro
AU - Kobayashi, Kiyonori
AU - Matsuhashi, Tamotsu
AU - Komaki, Yuga
AU - Watanabe, Kazuhiro
AU - Niikura, Ryota
AU - Suzuki, Nobumi
N1 - Publisher Copyright:
© 2024. Thieme. All rights reserved.
PY - 2024/3/28
Y1 - 2024/3/28
N2 - Background The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy. Methods We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6% received endoscopic treatment. Results 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5% vs. right colon 28.6%) and etiologies (diverticular bleeding 27.5% vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49 0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95%CI 0.29 0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95%CI 0.41 0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. Conclusions A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.
AB - Background The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy. Methods We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6% received endoscopic treatment. Results 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5% vs. right colon 28.6%) and etiologies (diverticular bleeding 27.5% vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49 0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95%CI 0.29 0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95%CI 0.41 0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. Conclusions A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.
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U2 - 10.1055/a-2232-9630
DO - 10.1055/a-2232-9630
M3 - Article
C2 - 38354743
AN - SCOPUS:85187301018
SN - 0013-726X
VL - 56
SP - 291
EP - 301
JO - Endoscopy
JF - Endoscopy
IS - 4
ER -