Mo1777 IS URGENT COLONOSCOPY NECESSARY IN PATIENTS WITH ACUTE LOWER GASTROINTESTINAL BLEEDING: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

The timing of colonoscopy for patients presenting with acute lower gastrointestinal bleeding (A-LGIB) is uncertain. Urgent colonoscopy (UC) may yield a specific diagnosis and allow for endoscopic hemostasis but could potentially increase adverse events with under-resuscitation. Elective colonoscopy (EC) can be performed after the patient is adequately resuscitated and prepped, however, this could lower detection rate of bleeding lesions. An electronic database search was conducted (PubMed, Embase, Google Scholar and Cochrane) for studies comparing urgent and elective colonoscopy in patients with A-LGIB. After hospital admission for A-LGIB, patients in the UC group underwent colonoscopy within 24 hours (range: 8-24) whereas a colonoscopy was performed after 24 hours (range: 24-72hrs) in the EC group. The primary outcome was 30-day re-bleeding rate after the initial procedure. Secondary outcomes were localization of the source of bleed, the rate of endoscopic treatment performed during colonoscopy, need for repeat colonoscopy, mortality and need for surgery. Pooled rates were expressed as proportions of events over total patients (%) with 95% confidence limits with heterogeneity (I2) and p-value of <0.05 for significance. Four randomized controlled trials (RCTs) were included in the final analysis with 206 patients in the UC group (mean age 64.7 years, 61.7% males) and 234 patients in the EC group (mean age 67.2 years, 62.1% males). The mean hemoglobin prior to colonoscopy in UC and EC groups were 10.3 vs 10.5mg/dL (p=0.19) and the mean time to colonoscopy was 13.4 hours vs 44.2 hours (p-<.0001) respectively. There was no significant difference in the 30- day rebleeding rate in both the groups, 21.3% vs 15.2%; OR 1.7 (95% CI, 0.79-3.66; I2 45%, P= 0.14) in the UC and EC group respectively (Figure 1). Similarly, there was no significant difference in any of the secondary outcomes between the two groups: Detection of bleeding source (27.5% vs 18.8%), endoscopic therapy performed during colonoscopy, (20.2% vs 12.2%), need for repeat endoscopy (3 studies; 21.1% vs 15.8%), mortality (1% vs 0.9%) and need for surgery (1.9% vs 2.8%) (table 1). This systematic review and meta-analysis of RCT’s demonstrates that in patients admitted with acute lower GI bleeding, the outcomes for urgent (within 24 hours) and elective colonoscopy (within 72 hours) are comparable with respect to re-bleeding rates ,need for endoscopic interventions, repeat colonoscopy, localization of source of bleed, mortality and need for surgery. Colonoscopy can thus be performed within 72 hours of patient admission after confirming hemodynamic stability and adequate bowel preparation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)