Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2022; 14(12): 759-768
Published online Dec 16, 2022. doi: 10.4253/wjge.v14.i12.759
Effectiveness of early colonoscopy in patients with colonic diverticular hemorrhage: A single-center retrospective cohort study
Chikamasa Ichita, Sayuri Shimizu, Akiko Sasaki, Chihiro Sumida, Takashi Nishino, Karen Kimura
Chikamasa Ichita, Akiko Sasaki, Chihiro Sumida, Takashi Nishino, Karen Kimura, Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
Chikamasa Ichita, Sayuri Shimizu, Department of Health Data Science, Yokohama City University, Yokohama 236-0027, Kanagawa, Japan
Author contributions: Ichita C, Shimizu S, Sasaki A, Sumida C, Nishino T, and Kimura K contributed equally to this work; Ichita C contributed to the planning, data gathering, literature review, writing and editing of this article; Shimizu S provided epidemiological advice and reviewed for statistical analysis; Sasaki A, Sumida C, Nishino T, and Kimura K provided professional suggestions in the conduct of the study; all authors commented on draft versions and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the Future Medical Research Center Ethical Committee (IRB No. TGE01304-024).
Informed consent statement: Due to the observational study based on medical records without using samples taken from the human body, informed consent was obtained from all participants through the opt-out method on our hospital website.
Conflict-of-interest statement: All the authors have no conflicts of interest directly relevant to the content of this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at ichikamasa@yahoo.co.jp.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chikamasa Ichita, MD, Doctor, Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura 247-8533, Kanagawa, Japan. ichikamasa@yahoo.co.jp
Received: October 11, 2022
Peer-review started: October 11, 2022
First decision: October 26, 2022
Revised: November 1, 2022
Accepted: November 22, 2022
Article in press: November 22, 2022
Published online: December 16, 2022
Processing time: 63 Days and 16.6 Hours
Abstract
BACKGROUND

Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding; however, the evidence in support for colonic diverticular hemorrhage (CDH) indications remains insufficient.

AIM

To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.

METHODS

We conducted a single-center retrospective cohort study. Patients who underwent colonoscopy within 24 h of presentation (early group) were compared with those who underwent colonoscopy beyond 24 h of presentation (elective group). The primary outcome was the length of hospital stay, and secondary outcomes were the identification of stigmata of recent hemorrhage (SRH), rebleeding, red blood cell transfusion more than 4 units, and interventional radiology and abdominal surgery after colonoscopy.

RESULTS

We identified 574 CDH cases. Patients were divided into the early (n = 328) and elective (n = 226) groups. After propensity score matching, 191 pairs were generated. The length of hospital stay did not significantly differ between the two groups (early group vs elective group; median, 7 vs 8 d; P = 0.10). The early group had a significantly high identification of SRH (risk difference, 11.6%; 95%CI: 2.7 to 20.3; P = 0.02). No significant differences were found in the rebleeding (risk difference, 4.7%; 95%CI: -4.1 to 13.5; P = 0.35), red blood cell transfusion more than 4 units (risk difference, 1.6%; 95%CI: -7.5 to 10.6; P = 0.82), and interventional radiology and abdominal surgery rate after colonoscopy (risk difference, 0.5%; 95%CI: -2.2 to 3.2; P = 1.00).

CONCLUSION

Early colonoscopy within 24 h, on arrival for CDH, could not improve the length of hospital stay.

Keywords: Colonic diverticular hemorrhage; Colonic diverticular bleeding; Diverticular hemorrhage; Diverticular bleeding; Early colonoscopy; Colonoscopy

Core Tip: Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding; however, the evidence in support for colonic diverticular hemorrhage (CDH) indications remains insufficient. We investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH. The purpose of the study was to compare the length of hospital stay for CDH by dividing patients into two groups: An early group who underwent colonoscopy within 24 h and an elective group who underwent colonoscopy beyond 24 h and analysis was performed using propensity score matching. Early colonoscopy did not improve the length of hospital stay.