High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan

Tomonori Aoki; Eiji Sadashima; Katsumasa Kobayashi; Atsushi Yamauchi; Atsuo Yamada; Jun Omori; Takashi Ikeya; Taiki Aoyama; Naoyuki Tominaga; Yoshinori Sato; Takaaki Kishino; Naoki Ishii; Tsunaki Sawada; Masaki Murata; Akinari Takao; Kazuhiro Mizukami; Ken Kinjo; Shunji Fujimori; Takahiro Uotani; Minoru Fujita; Hiroki Sato; Yoku Hayakawa; Mitsuhiro Fujishiro; Mitsuru Kaise; Naoyoshi Nagata; CODE BLUE-J Study collaborators

doi:10.1055/a-2232-9630

Endoscopy, Inhaltsverzeichnis

Endoscopy 2024; 56(04): 291-301
DOI: 10.1055/a-2232-9630

Original article

High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan

Tomonori Aoki‡^‡

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Eiji Sadashima

²Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan

,

Katsumasa Kobayashi

³Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Atsushi Yamauchi

⁴Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan

,

Atsuo Yamada

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Jun Omori

⁵Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

,

Takashi Ikeya

⁶Department of Gastroenterology, St. Luke's International University, Tokyo, Japan

,

Taiki Aoyama

⁷Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

,

Naoyuki Tominaga

⁸Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan

,

Yoshinori Sato

⁹Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan

,

Takaaki Kishino

¹⁰Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

,

Naoki Ishii

¹¹Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan

,

Tsunaki Sawada

¹²Department of Endoscopy, Nagoya University Hospital, Aichi, Japan

,

Masaki Murata

¹³Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

,

Akinari Takao

¹⁴Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

,

Kazuhiro Mizukami

¹⁵Department of Gastroenterology, Oita University, Oita, Japan

,

Ken Kinjo

¹⁶Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

,

Shunji Fujimori

¹⁷Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan

,

Takahiro Uotani

¹⁸Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan

,

Minoru Fujita

¹⁹Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan

,

Hiroki Sato

²⁰Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Yoku Hayakawa

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Mitsuhiro Fujishiro

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Mitsuru Kaise

⁵Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

,

Naoyoshi Nagata‡^‡

²¹Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan

²²Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan

,

CODE BLUE-J Study collaborators

(

Sho Suzuki

²³Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan

,

Toshiaki Narasaka

²⁴Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan

²⁵Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki Japan

,

Junnosuke Hayasaka

²⁶Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

,

Tomohiro Funabiki

²⁷Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan

²⁸Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

,

Yuzuru Kinjo

²⁹Department of Gastroenterology, Naha City Hospital, Okinawa, Japan

,

Akira Mizuki

³⁰Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan

,

Shu Kiyotoki

³¹Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan

,

Tatsuya Mikami

³²Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan

,

Ryosuke Gushima

³³Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

,

Hiroyuki Fujii

³⁴Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan

,

Yuta Fuyuno

³⁵Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

,

Takuto Hikichi

³⁶Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

,

Yosuke Toya

³⁷Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan

,

Kazuyuki Narimatsu

³⁸Department of Internal Medicine, National Defense Medical College, Saitama, Japan

,

Noriaki Manabe

³⁹Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan

,

Koji Nagaike

⁴⁰Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan

,

Tetsu Kinjo

⁴¹Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan

,

Yorinobu Sumida

⁴²Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

,

Sadahiro Funakoshi

⁴³Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan

,

Kiyonori Kobayashi

⁴⁴Department of Gastroenterology, Kitasato University, School of Medicine, Kanagawa, Japan

,

Tamotsu Matsuhashi

⁴⁵Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan

,

Yuga Komaki

⁴⁶Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

⁴⁷Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

,

Kazuhiro Watanabe

²²Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan

,

Ryota Niikura

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

²¹Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan

,

Nobumi Suzuki

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Yosuke Tsuji

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

)› Institutsangaben

Abstract

Background The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy.

Methods We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6 % received endoscopic treatment.

Results 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5 % vs. right colon 28.6 %) and etiologies (diverticular bleeding 27.5 % vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49–0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95 %CI 0.29–0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95 %CI 0.41–0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding.

Conclusions A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.

Volltext

Referenzen

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