Urgent colonoscopy in gastro-intestinal bleeding: when is it truly useful?

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Aims Lower gastrointestinal bleeding represents a significant clinical challenge in terms of the efficacy of endoscopic treatments. Furthermore, the role of urgent colonoscopy is often not clear in the available studies. The aim of our study is to evaluate the efficacy of urgent colonoscopy in managing gastrointestinal bleeding. Methods A retrospective analysis of urgent procedures performed at a tertiary referral center from July 2018 to January 2024 was conducted. The patient series was divided into three subgroups: “naive colon” (patients who have never undergone interventional endoscopic procedures or surgical procedures), “post-polypectomy”, and “post-surgery”. Clinical success was defined as the absence of further intervention required to manage bleeding [ 1 ] [ 2 ] [ 3 ]. Results We identified 200 instances of bleeding out of 322 urgent colonoscopies. Etiology of bleeding was not identified in 77 out of 122 patients in the naive group (63%), in 5 out of 42 patients in the post-polypectomy group (12%), and 10 out of 36 patients in the post-surgery group (28%) (Fisher test for multiple variables, p=0,03). We were able to perform hemostasis in 19 patients in the naive group (16%), in 36 patients in the post-polypectomy group (86%), and in 20 patients in the post-surgery group (56%) (Fisher test, p=0,01). As regards clinical success in the “naive” colon subgroup, we achieved success in 104 patients (83%): particularly the success rate was 80% when the etiology was undetermined (67 cases), 50% when the etiology was established (20 cases), and 90% when hemostasis was performed (13 cases) (Fisher test, p=0,9). In the “post-polypectomy” subgroup, we achieved success in 37 patients (88%): 40% success when the etiology was undetermined (2 cases), 100% when the etiology was established (1 case), and 92% when hemostasis was performed (33 cases) (Fisher test, p=0,07; Chi-squared test: undermined etiology vs performed hemostasis, p=0,8). In the subgroup of patients who had recently undergone surgery, we achieved success in 31 patients (86%): with a success rate of 70% when the etiology was undetermined (7 cases), 100% when the etiology was established (5 cases), and 90% when hemostasis was performed (18 cases) (Fisher test, p=0,9). Conclusions In conclusion, our study highlights the notably limited diagnostic and therapeutic efficacy of colonoscopies performed on naive colons (those not previously subjected to surgery or recent polypectomy) as opposed to the diagnostic and therapeutic efficacy when in the other two aforementioned subgroups. These results underscore the need for strategies tailored to the specific characteristics and medical history of patients presenting with lower gastrointestinal bleeding. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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