Endoscopic hemostasis is rarely used for hematochezia: a聽population-based study from the Clinical Outcomes Research Initiative National Endoscopic Database

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• 作者：Osnat Ron-Tal Fisher ; Ian M. Gralnek ; Glenn M. Eisen ; J. Luke Williams ; Jennifer L. Holub
• 关键词：AE ; adverse event ; ASA ; American Society of Anesthesiologists ; AVM ; arteriovenous malformation ; CORI ; Clinical Outcomes Research Initiative ; LGIB ; lower GI bleeding ; NED ; National Endoscopic Database
• 刊名：Gastrointestinal Endoscopy
• 出版年：February, 2014
• 年：2014
• 卷：79
• 期：2
• 页码：317-325
• 全文大小：442 K

文摘

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Background

Data on the use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings.

Objectives

To characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who did and did not receive endoscopic hemostasis.

Design

Retrospective analysis.

Setting

Clinical Outcomes Research Initiative National Endoscopic Database, 2002 to聽2008.

Patients

Adults with hematochezia.

Interventions

None.

Main Outcome Measurements

Demographics, comorbidities, practice setting, adverse events, and colonoscopy procedural characteristics and findings.

Results

We identified 3151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), white (83.3%), and older (mean age 70.9 卤 12.3 years); had a low-risk American Society of Anesthesiologists classification (53.9%); and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be white (83.3% vs 71.0%, m>Pm>聽= .02), have more comorbidities (classes 3 and 4, 46.2% vs 36.0%, m>Pm>聽= .04), and have the cecum reached (95.8% vs 87.7%, m>Pm>聽=聽.003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of arteriovenous malformations (32.6% vs 2.6%, m>Pm>聽= .0001) or a solitary ulcer (8.3% vs 2.1%, m>Pm>聽< .0001).

Limitations

Retrospective database analysis.

Conclusions

Less than 5% of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights into in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia.