Early Versus Delayed Colonoscopy in Hospitalized Patients With Lower Gastrointestinal Bleeding: A Meta-Analysis

Abstract

Background: Early colonoscopy is recommended for patients with severe lower gastrointestinal bleeding (LGIB). There is limited data as to whether this is associated with improved outcomes.

Methods: We performed a meta-analysis of studies comparing early (<24 h) versus delayed colonoscopy (>24 h). PubMed, Embase, and Web of Science were searched for manuscripts using colonoscopy as a diagnostic/treatment modality for patients hospitalized with LGIB. Studies were included if data were available on outcomes comparing early and delayed colonoscopy. Articles were reviewed for time to colonoscopy, rebleeding, mortality, length of stay (LOS), surgery, interventions, localization of LGIB, and number of packed red blood cells. Pooled measures were reported using the Mantel-Haenszel method.

Results: A total of 8491 studies were assessed of which 6 were included. There were 422 patients in the early arm and 479 in the delayed arm. There were no differences in age (64.2 vs. 65.7, P=0.85), admission hemoglobin (10.3 vs. 10.3 g/dL, P=0.96), LOS (5.21 vs. 6.09, P=0.52), and packed red blood cells transfusion (2.37 vs. 2.35, P=0.92) between the groups. In hospital mortality [odds ratio (OR), 1.64; 95% confidence interval (CI), 0.51-5.32], rebleeding (OR, 1.38; 95% CI, 0.85-2.23) and need for surgery (OR, 0.89; 95% CI, 0.42-1.89) were not different in delayed versus early colonoscopy. Early colonoscopy was associated with a higher detection of bleeding source (OR, 2.97; 95% CI, 2.11-4.19) and endoscopic intervention (OR, 3.99; 95% CI, 2.59-6.13).

Conclusions: Early colonoscopy is not associated with reduced rebleeding, LOS, or surgery but is associated with a higher rate of source localization and endoscopic intervention.