Early Colonoscopy After Stable Diverticular Bleeding Reduces 30-Day Mortality

Early colonoscopy within a week of stable diverticular bleeds reduces mortality risk in these patients during the subsequent 30 days compared with colonoscopies performed after 1 week, according to study results presented at the American College of Gastroenterology (ACG) 2022 Annual Meeting, held from October 21 to 26, 2022, in Charlotte, North Carolina, and virtually.

Many major medical organizations specializing in gastrointestinal care strongly urge early colonoscopies within 24 to 48 hours of lower gastrointestinal bleeds, 20% to 40% of which are diverticular bleeds.

Researchers in the United States (US) conducted a retrospective, case-control study to assess the benefits and risks of early colonoscopy in patients with stable diverticular bleeding. They obtained data from a large national database comprising information from 59 healthcare organizations throughout the US.

The researchers identified 13,890 and 103,718 patients with stable diverticular bleeding who underwent colonoscopy following their bleeding episodes before and after 7 days, respectively. After matching 12,502 patients each into an early intervention group and a control group, they compared patient outcomes.

The researchers excluded patients admitted to the intensive care unit (ICU) or who had comorbidities such as peptic ulcers, esophageal varices, angiodysplasias, platelet disorders, complement factor deficiencies, and gastrointestinal cancer.

Patients who underwent colonoscopy after 7 days following their diverticular bleeding episodes demonstrated a significantly higher risk of 30-day mortality compared with patients who underwent early colonoscopies (odds ratio [OR], 1.8; 95%, CI, 1.33-2.41).

In contrast, patients in the late colonoscopy group demonstrated a lower risk for hospital readmission within 30 days compared with the early colonoscopy group (OR, 0.88; 95% CI, 0.82-0.95).

Neither early nor late colonoscopies significantly affected the need for blood transfusions in this patient population (OR, 1.00; 95% CI, 0.72-1.40).

“Early colonoscopy within 7 days seems to confer a survival benefit in patients with stable diverticular bleeds when compared to performing colonoscopy after 7 days,” the researchers stated. “Large prospective randomized controlled trials would be necessary to confirm these findings.”