Urgent vs. Elective colonoscopy for lower gastrointestinal bleeding: Meta-analysis of randomized controlled trials
Kamal F, Khan MA, Marella HK, Reddy YK, Haq KF, Bayoumi M, Akbar H, Heda RP, and Tombazzi C. Urgent vs. Elective colonoscopy for lower gastrointestinal bleeding: Meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy 2020; 91(6):AB494.
Background: Acute lower gastrointestinal (GI) bleeding (LGIB) is a common cause for hospitalization; colonoscopy is recommended for diagnostic evaluation and possible treatment. However, the optimal timing of colonoscopy is controversial. Urgent colonoscopy (i.e., within 24 hours) is often performed but its benefits are unclear. There is limited evidence to support the use of urgent colonoscopy in acute LGIB. Some studies have compared the role of urgent vs. elective colonoscopy in management. Aim: To compare urgent vs. elective colonoscopy in the management of acute LGIB by meta-analysis of mrandomized controlled trials (RCTs) Methods: To identify RCTs comparing urgent vs. elective colonoscopy in LGIB, we searched databases including Pubmed, Scopus, Cochrane library and web of science from inception to October 2019. The outcomes we evaluated included rate of rebleeding, stigmata of recent hemorrhage (SRH), identification of bleeding source, mortality, need for surgery and length of hospital stay. For categorical variables, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random effects model. For continuous variables, standard mean differences (SMD) with 95% CI were calculated. Quality was assessed using Cochrane tool for assessing risk of bias for RCTs. Results: We included 4 RCTs with 460 patients; 228 underwent urgent colonoscopy and 235 underwent elective colonoscopy. Results are summarized in Table 1 and depicted graphically in Figure 1. There were no significant differences in detection of SRH, mortality, need for surgery or endoscopic intervention. There were no significant differences in identification of a source of bleeding; pooled OR (95% CI): 1.88 (0.87, 4.05), I2= 43% (Figure 1A) or rates of rebleeding between groups; pooled OR: 1.68 (0.79, 3.59) I2= 44% (Figure 1B). There were low levels of heterogeneity in analysis of these outcomes. There was no significant difference in length of hospital stay between groups; SMD (95%) CI= 0.12 (-0.23, 0.46), I2= 60%. This analysis was limited by moderate heterogeneity probably due to differences in discharge criteria in different countries. All RCTs had high risk of performance bias and low risk of selection, detection, attrition and reporting bias. Conclusions: There is no evidence that urgent colonoscopy decreases rates of rebleeding, mortality or need for surgery in patients with LGIB or that it increases the rates of detection of sources of bleeding or SRH.