Introduction: Patients with acute gastrointestinal bleeding present a unique clinical challenge. Timing of endoscopy is often debated. A previous study showed no benefit for early ( < 6 hours) endoscopy in terms of mortality, need for surgery or transfusion requirements; while another showed benefits for early ( < 12 hours) endoscopy. We evaluated the effects of endoscopy time for acute upper and lower GI bleeding on mortality, length of hospitalization, need for repeat endoscopy, and transfusion requirements. Methods: In this IRB-approved study, a retrospective chart review included all patients with gastrointestinal bleeding, admitted to a tertiary care, university-based hospital between July 2007 and September 2015 who underwent a colonoscopy while hospitalized. Data were collected for timing of colonoscopy (emergent vs. elective >24 hours), rate of re-bleeding, length of hospitalization, and time to death. Results: A total of 446 patients were eligible for chart review; 47 were excluded who did not present for GI bleeding or did not undergo a colonoscopy. Of the 399 patients studied, 29 had an emergent colonoscopy. The population median age was 62 years, 49% were male, and 84% Caucasian. There were no differences in colonoscopy timing for gender, race, smoking status, alcohol use, prescribed medications or vital signs at admission. We observed no significant difference in days of hospitalization for emergent versus elective colonoscopy (geometric mean; 95% CI: 4.6; 3.4-6.3 vs. 4.4; 3.7-4.3, p=0.43). Using a multivariable model to control for factors at admission associated with length of hospital stay, time of colonoscopy remained unrelated (p=0.24). The early endoscopy group had higher re-bleeding occurrence compared to the elective group (27% vs 6%, p=0.00022). Using Cox proportional regression, right censored for living patients, those with earlier colonoscopy had shorter time to death compared to the non-emergent group (p=0.018). Conclusion: While endoscopic investigation for patients presenting with lower gastrointestinal bleeding is vital for the diagnosis and treatment of such patients, the timing of the procedure also plays an important role in the management. Performing colonoscopy too soon may have a negative impact on patient care related to increased occurrence of re-bleeding and death. Adequate resuscitative measures should be thoroughly carried out prior to performing emergent colonoscopy to optimize clinical scenario.
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Winn et al. (2016) studied this question.