PMID- 29487627
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220316
IS  - 1756-283X (Print)
IS  - 1756-2848 (Electronic)
IS  - 1756-283X (Linking)
VI  - 11
DP  - 2018
TI  - The role of early colonoscopy in patients presenting with acute lower 
      gastrointestinal bleeding: a systematic review and meta-analysis.
PG  - 1756283X18757184
LID - 10.1177/1756283X18757184 [doi]
LID - 1756283X18757184
AB  - OBJECTIVE: The use of early colonoscopy in the management of acute lower 
      gastrointestinal bleeding (LGIB) is controversial, with disparate evidence. We 
      aim to formally characterize the utility of early colonoscopy (within 24 h) in 
      managing acute LGIB. DESIGN: A systematic literature search to August 2016 
      identified fully published and abstracts of randomized controlled trials (RCTs) 
      and observational studies assessing early colonoscopy in acute LGIB. Single-arm 
      studies were also included to define incidence. Primary outcomes were overall 
      rebleeding rates and time to rebleeding. Secondary outcomes included mortality, 
      surgery, length of stay (LOS), definite cause of bleeding and adverse events 
      (AEs). Odds ratios (OR) and weighted mean differences (WMD) were calculated. 
      RESULTS: Of 897 citations, 10 single-arm, 9 observational studies, and 2 RCTS 
      were included (25,781 patients). Rebleeding was no different between patients 
      undergoing early colonoscopy and controls (seven studies, OR = 0.89, 95% CI 
      0.49-1.62), or RCT data only (OR = 1.00, 95% CI 0.52-1.62). Early colonoscopy 
      detected more definitive sources of bleeding (OR = 4.12, 95% CI 2.00-8.49), and 
      was associated with shorter LOS colonoscopy (WMD = -1.52, 95% CI -2.54 to -0.50 
      days). No other differences were noted between early and late colonoscopy. AEs 
      occurred in 4.0%, (95% CI 2.9%; 5.4%) of early colonoscopies. Included studies 
      were of low quality, with significant heterogeneity for some outcomes. 
      CONCLUSION: Early colonoscopy in acute LGIB does not decrease rebleeding, 
      mortality or need for surgery, but is associated with increased detection of 
      definitive sources of bleeding, shorter LOS, with low complication incidence. 
      However, the quality of evidence is low, highlighting the need for additional 
      high-level studies.
FAU - Roshan Afshar, Ira
AU  - Roshan Afshar I
AD  - Division of Gastroenterology, McGill University Health Centre, McGill University, 
      Montreal, Quebec, Canada.
FAU - Sadr, Mo Seyed
AU  - Sadr MS
AD  - University of British Columbia, Division of Neurosurgery, BC, Canada.
FAU - Strate, Lisa L
AU  - Strate LL
AD  - Division of Gastroenterology, University of Washington School of Medicine, 
      Seattle, Washington, USA.
FAU - Martel, Myriam
AU  - Martel M
AD  - Division of Gastroenterology, McGill University Health Centre, McGill University, 
      Montreal, Quebec, Canada.
FAU - Menard, Charles
AU  - Menard C
AD  - Medicine, University of Sherbrooke, Sherbrooke, Canada.
FAU - Barkun, Alan N
AU  - Barkun AN
AD  - McGill University and the McGill University Health Centre, 1650 Cedar Avenue, 
      D7.346, Montreal, Quebec, H3G1A4, Canada.
LA  - eng
PT  - Journal Article
DEP - 20180219
PL  - England
TA  - Therap Adv Gastroenterol
JT  - Therapeutic advances in gastroenterology
JID - 101478893
PMC - PMC5821297
OTO - NOTNLM
OT  - acute LGIB
OT  - early colonoscopy
OT  - meta-analyses
OT  - rebleeding
COIS- Conflict of interest statement: The authors declare that there is no conflict of 
      interest.
EDAT- 2018/03/01 06:00
MHDA- 2018/03/01 06:01
PMCR- 2018/02/19
CRDT- 2018/03/01 06:00
PHST- 2017/10/02 00:00 [received]
PHST- 2017/12/19 00:00 [accepted]
PHST- 2018/03/01 06:00 [entrez]
PHST- 2018/03/01 06:00 [pubmed]
PHST- 2018/03/01 06:01 [medline]
PHST- 2018/02/19 00:00 [pmc-release]
AID - 10.1177_1756283X18757184 [pii]
AID - 10.1177/1756283X18757184 [doi]
PST - epublish
SO  - Therap Adv Gastroenterol. 2018 Feb 19;11:1756283X18757184. doi: 
      10.1177/1756283X18757184. eCollection 2018.