Su1058 OUTCOMES OF EARLY VS. ELECTIVE COLONOSCOPY IN THE MANAGEMENT OF ACUTE LOWER GASTROINTESTINAL BLEEDING

The incidence of lower gastrointestinal bleeding (LGIB) has been steadily rising. This translates into an increased burden on healthcare resources as patients with LGIB require hospitalization and invasive diagnostic testing. Studies evaluating the role of early colonoscopy in LGIB have reached conflicting results. We aimed to perform a systematic review and meta-analysis to evaluate the role of urgent vs. elective colonoscopy in the management of LGIB. Outcome measures included: source of bleeding identified (stigmata of recent hemorrhage or definite source of bleeding), therapeutic interventions performed, patients requiring a blood transfusion, hospital length of stay (LOS), rebleeding rate, and mortality. We included trials comparing urgent colonoscopy in lower GI bleeding to elective colonoscopy. We searched Medline, Embase, and Cochrane databases through November 2019. Eligible studies were searched for variables of interest. Statistical analyses were performed using the R Programming Language. Pooled rates of variables were reported as odds ratio (OR) and mean difference (MD) with 95% confidence interval, and heterogeneity was reported as I2 statistics. Thirteen studies were eligible and included in our analysis. Four were randomized controlled trials. Early colonoscopy was defined as procedure within 24 hours in 11 studies. Identification of bleeding source was higher in the early colonoscopy group (OR= 2.67, 1.66-4.32, I2=60%; Figure 1). However, the use of endoscopic therapy was similar between both groups (OR= 1.5, 0.84-2.67). There were no significant differences in transfusion requirements and rebleeding rates (Figure 2). Early colonoscopy lead to a significantly shorter LOS (MD= -0.69, -1.23; -0.14). Mortality was higher in the elective colonoscopy group (OR=0.84, 0.73-0.97); however, this was largely driven by two national database studies. Urgent colonoscopy in LGIB resulted in a higher rate of identification of bleeding source without significantly affecting the need for endoscopic intervention. Shorter length of stay by 0.69 days on average was noted with early colonoscopy. However, other patient-centered outcomes such as rebleeding rate and transfusion requirements were not affected. The small mortality benefit for elective colonoscopy is largely driven by two national database studies and likely due to confounding variables in the population. Additional high-quality comparative data is needed with a focus on improved clinical outcomes. Colonoscopy in LGIB appears reasonable within the first 24 hours; however, limitations in available data on patient-centered outcomes should cause reservation from endoscopists performing urgent colonoscopy if there remain concerns about adequate stabilization, availability of resources, or endoscopic expertise.Forest plot of 30-day rebleeding rate in urgent vs elective colonoscopyView Large Image Figure ViewerDownload Hi-res image Download (PPT)