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

Research output: Contribution to journalArticlepeer-review

8 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 languageEnglish
Pages (from-to)2222-2234
Number of pages13
JournalAmerican Journal of Gastroenterology
Volume116
Issue number11
DOIs
Publication statusPublished - 01-11-2021

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Fingerprint

Dive into the research topics of 'Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases with Hematochezia: CODE BLUE-J Study'. Together they form a unique fingerprint.

Cite this