Development and validation of a novel model for predicting stigmata of recent hemorrhage in acute lower gastrointestinal bleeding: Multicenter nationwide study

Tomonori Aoki¹, Atsuo Yamada¹, Katsumasa Kobayashi², Atsushi Yamauchi³, Jun Omori⁴, Takashi Ikeya⁵, Taiki Aoyama⁶, Naoyuki Tominaga⁷, Yoshinori Sato⁸, Takaaki Kishino⁹, Naoki Ishii¹⁰, Tsunaki Sawada¹¹, Masaki Murata¹², Akinari Takao¹³, Kazuhiro Mizukami¹⁴, Ken Kinjo¹⁵, Shunji Fujimori¹⁶, Takahiro Uotani¹⁷, Minoru Fujita¹⁸, Hiroki Sato¹⁹, Sho Suzuki²⁰, Toshiaki Narasaka^{21

22}, Junnosuke Hayasaka²³, Tomohiro Funabiki^{24

25}, Yuzuru Kinjo²⁶, Akira Mizuki²⁷, Mitsuhiro Fujishiro¹, Mitsuru Kaise⁴, Naoyoshi Nagata^{28

29}; Collaborators

Collaborators, Affiliations

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
³ Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.
⁴ Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
⁵ Department of Gastroenterology, St. Luke's International University, Tokyo, Japan.
⁶ Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
⁷ Department of Gastroenterology, Saga-Ken Medical Center Koseikan, Saga, Japan.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
⁹ Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
¹⁰ Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
¹¹ Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.
¹² Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
¹³ Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
¹⁴ Department of Gastroenterology, Oita University, Oita, Japan.
¹⁵ Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
¹⁶ Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
¹⁷ Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
¹⁸ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
¹⁹ Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²⁰ Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan.
²¹ Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan.
²² Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan.
²³ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
²⁴ Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
²⁵ Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan.
²⁶ Department of Gastroenterology, Naha City Hospital, Okinawa, Japan.
²⁷ Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
²⁸ Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
²⁹ Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.

PMID: 36754979
DOI: 10.1111/den.14533

Multicenter Study

Development and validation of a novel model for predicting stigmata of recent hemorrhage in acute lower gastrointestinal bleeding: Multicenter nationwide study

Tomonori Aoki et al. Dig Endosc. 2023 Sep.

. 2023 Sep;35(6):777-789.

doi: 10.1111/den.14533. Epub 2023 Mar 28.

Authors

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
³ Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.
⁴ Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
⁵ Department of Gastroenterology, St. Luke's International University, Tokyo, Japan.
⁶ Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
⁷ Department of Gastroenterology, Saga-Ken Medical Center Koseikan, Saga, Japan.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
⁹ Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
¹⁰ Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
¹¹ Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.
¹² Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
¹³ Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
¹⁴ Department of Gastroenterology, Oita University, Oita, Japan.
¹⁵ Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
¹⁶ Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
¹⁷ Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
¹⁸ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
¹⁹ Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²⁰ Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan.
²¹ Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan.
²² Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan.
²³ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
²⁴ Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
²⁵ Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan.
²⁶ Department of Gastroenterology, Naha City Hospital, Okinawa, Japan.
²⁷ Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
²⁸ Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
²⁹ Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.

PMID: 36754979
DOI: 10.1111/den.14533

Abstract

Objectives: Stigmata of recent hemorrhage (SRH) directly indicate a need for endoscopic therapy in acute lower gastrointestinal bleeding (LGIB). Colonoscopy would be prioritized for patients with highly suspected SRH, but the predictors of colonic SRH remain unclear. We aimed to construct a predictive model for the efficient detection of SRH using a nationwide cohort.

Methods: We retrospectively analyzed 8360 patients admitted through hospital emergency departments for acute LGIB in the CODE BLUE-J Study (49 hospitals throughout Japan). All patients underwent inpatient colonoscopy. To develop an SRH predictive model, 4863 patients were analyzed. Baseline characteristics, colonoscopic factors (timing, preparation, and devices), and computed tomography (CT) extravasation were extensively assessed. The performance of the model was externally validated in 3497 patients.

Results: Colonic SRH was detected in 28% of patients. A novel predictive model for detecting SRH (CS-NEED score: ColonoScopic factors, No abdominal pain, Elevated PT-INR, Extravasation on CT, and DOAC use) showed high performance (area under the receiver operating characteristic curve [AUC] 0.74 for derivation and 0.73 for external validation). This score was also highly predictive of active bleeding (AUC 0.73 for derivation and 0.76 for external validation). Patients with low (0-6), intermediate (7-8), and high (9-12) scores in the external validation cohort had SRH identification rates of 20%, 31%, and 64%, respectively (P < 0.001 for trend).

Conclusions: A novel predictive model for colonic SRH identification (CS-NEED score) can specify colonoscopies likely to achieve endoscopic therapy in acute LGIB. Using the model during initial management would contribute to finding and treating SRH efficiently.

Keywords: active bleeding; computed tomography; lower gastrointestinal bleeding; predictive model; stigmata of recent hemorrhage.

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References

REFERENCES

1. Strate LL, Gralnek IM. ACG clinical guideline: Management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111: 459-74.
1. Nagata N, Ishii N, Manabe N et al. Guidelines for colonic diverticular bleeding and colonic diverticulitis: Japan Gastroenterological Association. Digestion 2019; 99 (Suppl 1): 1-26.
1. Oakland K, Chadwick G, East JE et al. Diagnosis and management of acute lower gastrointestinal bleeding: Guidelines from the British Society of Gastroenterology. Gut 2019; 68: 776-89.
1. Triantafyllou K, Gkolfakis P, Gralnek IM et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2021; 53: 850-68.
1. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342: 78-82.

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Development and validation of a novel model for predicting stigmata of recent hemorrhage in acute lower gastrointestinal bleeding: Multicenter nationwide study

Collaborators

Affiliations

Development and validation of a novel model for predicting stigmata of recent hemorrhage in acute lower gastrointestinal bleeding: Multicenter nationwide study

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical