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

Naoyoshi Nagata; Katsumasa Kobayashi; Atsushi Yamauchi; Atsuo Yamada; Jun Omori; Takashi Ikeya; Taiki Aoyama; Naoyuki Tominaga; Yoshinori Sato; Takaaki Kishino; Naoki Ishii; Tsunaki Sawada; Masaki Murata; Akinari Takao; Kazuhiro Mizukami; Ken Kinjo; Shunji Fujimori; Takahiro Uotani; Minoru Fujita; Hiroki Sato; Sho Suzuki; Toshiaki Narasaka; Junnosuke Hayasaka; Tomohiro Funabiki; Yuzuru Kinjo; Akira Mizuki; Shu Kiyotoki; Tatsuya Mikami; Ryosuke Gushima; Hiroyuki Fujii; Yuta Fuyuno; Naohiko Gunji; Yosuke Toya; Kazuyuki Narimatsu; Noriaki Manabe; Koji Nagaike; Tetsu Kinjo; Yorinobu Sumida; Sadahiro Funakoshi; Kana Kawagishi; Tamotsu Matsuhashi; Yuga Komaki; Kuniko Miki; Kazuhiro Watanabe; Masakatsu Fukuzawa; Takao Itoi; Naomi Uemura; Takashi Kawai; Mitsuru Kaise

doi:10.14309/ajg.0000000000001413

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

Naoyoshi Nagata, Katsumasa Kobayashi, Atsushi Yamauchi, Atsuo Yamada, Jun Omori, Takashi Ikeya, Taiki Aoyama, Naoyuki Tominaga, Yoshinori Sato, Takaaki Kishino, Naoki Ishii, Tsunaki Sawada, Masaki Murata, Akinari Takao, Kazuhiro Mizukami, Ken Kinjo, Shunji Fujimori, Takahiro Uotani, Minoru Fujita, Hiroki SatoSho Suzuki, Toshiaki Narasaka, Junnosuke Hayasaka, Tomohiro Funabiki, Yuzuru Kinjo, Akira Mizuki, Shu Kiyotoki, Tatsuya Mikami, Ryosuke Gushima, Hiroyuki Fujii, Yuta Fuyuno, Naohiko Gunji, Yosuke Toya, Kazuyuki Narimatsu, Noriaki Manabe, Koji Nagaike, Tetsu Kinjo, Yorinobu Sumida, Sadahiro Funakoshi, Kana Kawagishi, Tamotsu Matsuhashi, Yuga Komaki, Kuniko Miki, Kazuhiro Watanabe, Masakatsu Fukuzawa, Takao Itoi, Naomi Uemura, Takashi Kawai, Mitsuru Kaise

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

40 Citations (Scopus)

Abstract

INTRODUCTION:The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia.METHODS:This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia.RESULTS:Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability.DISCUSSION:This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging.

Original language	English
Pages (from-to)	2222-2234
Number of pages	13
Journal	American Journal of Gastroenterology
Volume	116
Issue number	11
DOIs	https://doi.org/10.14309/ajg.0000000000001413
Publication status	Published - 01-11-2021

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Hepatology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.14309/ajg.0000000000001413

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Nagata, N., Kobayashi, K., Yamauchi, A., Yamada, A., Omori, J., Ikeya, T., Aoyama, T., Tominaga, N., Sato, Y., Kishino, T., Ishii, N., Sawada, T., Murata, M., Takao, A., Mizukami, K., Kinjo, K., Fujimori, S., Uotani, T., Fujita, M., ... Kaise, M. (2021). Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia: CODE BLUE-J Study. American Journal of Gastroenterology, 116(11), 2222-2234. https://doi.org/10.14309/ajg.0000000000001413

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title = "Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia: CODE BLUE-J Study",

abstract = "INTRODUCTION:The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia.METHODS:This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia.RESULTS:Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability.DISCUSSION:This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging.",

author = "Naoyoshi Nagata and Katsumasa Kobayashi and Atsushi Yamauchi and Atsuo Yamada and Jun Omori and Takashi Ikeya and Taiki Aoyama and Naoyuki Tominaga and Yoshinori Sato and Takaaki Kishino and Naoki Ishii and Tsunaki Sawada and Masaki Murata and Akinari Takao and Kazuhiro Mizukami and Ken Kinjo and Shunji Fujimori and Takahiro Uotani and Minoru Fujita and Hiroki Sato and Sho Suzuki and Toshiaki Narasaka and Junnosuke Hayasaka and Tomohiro Funabiki and Yuzuru Kinjo and Akira Mizuki and Shu Kiyotoki and Tatsuya Mikami and Ryosuke Gushima and Hiroyuki Fujii and Yuta Fuyuno and Naohiko Gunji and Yosuke Toya and Kazuyuki Narimatsu and Noriaki Manabe and Koji Nagaike and Tetsu Kinjo and Yorinobu Sumida and Sadahiro Funakoshi and Kana Kawagishi and Tamotsu Matsuhashi and Yuga Komaki and Kuniko Miki and Kazuhiro Watanabe and Masakatsu Fukuzawa and Takao Itoi and Naomi Uemura and Takashi Kawai and Mitsuru Kaise",

year = "2021",

month = nov,

day = "1",

doi = "10.14309/ajg.0000000000001413",

language = "English",

volume = "116",

pages = "2222--2234",

journal = "American Journal of Gastroenterology",

issn = "0002-9270",

publisher = "Wolters Kluwer Health",

number = "11",

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Nagata, N, Kobayashi, K, Yamauchi, A, Yamada, A, Omori, J, Ikeya, T, Aoyama, T, Tominaga, N, Sato, Y, Kishino, T, Ishii, N, Sawada, T, Murata, M, Takao, A, Mizukami, K, Kinjo, K, Fujimori, S, Uotani, T, Fujita, M, Sato, H, Suzuki, S, Narasaka, T, Hayasaka, J, Funabiki, T, Kinjo, Y, Mizuki, A, Kiyotoki, S, Mikami, T, Gushima, R, Fujii, H, Fuyuno, Y, Gunji, N, Toya, Y, Narimatsu, K, Manabe, N, Nagaike, K, Kinjo, T, Sumida, Y, Funakoshi, S, Kawagishi, K, Matsuhashi, T, Komaki, Y, Miki, K, Watanabe, K, Fukuzawa, M, Itoi, T, Uemura, N, Kawai, T & Kaise, M 2021, 'Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia: CODE BLUE-J Study', American Journal of Gastroenterology, vol. 116, no. 11, pp. 2222-2234. https://doi.org/10.14309/ajg.0000000000001413

TY - JOUR

T1 - Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia

T2 - CODE BLUE-J Study

AU - Nagata, Naoyoshi

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 - 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 - Gunji, Naohiko

AU - Toya, Yosuke

AU - Narimatsu, Kazuyuki

AU - Manabe, Noriaki

AU - Nagaike, Koji

AU - Kinjo, Tetsu

AU - Sumida, Yorinobu

AU - Funakoshi, Sadahiro

AU - Kawagishi, Kana

AU - Matsuhashi, Tamotsu

AU - Komaki, Yuga

AU - Miki, Kuniko

AU - Watanabe, Kazuhiro

AU - Fukuzawa, Masakatsu

AU - Itoi, Takao

AU - Uemura, Naomi

AU - Kawai, Takashi

AU - Kaise, Mitsuru

PY - 2021/11/1

Y1 - 2021/11/1

N2 - INTRODUCTION:The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia.METHODS:This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia.RESULTS:Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability.DISCUSSION:This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging.

AB - INTRODUCTION:The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia.METHODS:This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia.RESULTS:Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability.DISCUSSION:This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging.

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JO - American Journal of Gastroenterology

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

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