Open AccessAngiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation‐wide observational study
Author(s) -
Miyakuni Yasuhiko,
Nakajima Mikio,
Ohbe Hiroyuki,
Sasabuchi Yusuke,
Kaszynski Richard H.,
Ishimaru Miho,
Matsui Hiroki,
Fushimi Kiyohide,
Yamaguchi Yoshihiro,
Yasunaga Hideo
Publication year - 2020
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.533
Subject(s) - medicine , colonoscopy , angiography , propensity score matching , observational study , retrospective cohort study , radiology , confounding , lower gastrointestinal bleeding , hemostasis , surgery , colorectal cancer , cancer
Aim Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non‐endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy. Methods We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in‐hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score‐matched analyses were undertaken to adjust for confounders. Results We identified 6,546 eligible patients. The patients were divided into the colonoscopy group ( n = 5,737) and angiography group ( n = 809). After one‐to‐four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in‐hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group. Conclusions The present study revealed that in‐hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.