LOW CLINICAL EFFICACY OF EMERGENT SIGMOIDOSCOPY IN PATIENTS WITH OVERT LOWER GASTROINTESTINAL BLEEDING: A SINGLE CENTER STUDY

Aims:

Emergent sigmoidoscopy is commonly used as first diagnostic tool in patients with overt lower gastrointestinal bleeding (LGIB). However, it tis uncommon to find definite bleeding focus in emergent sigmoidoscopy and multiple diagnostic work-up studies are commonly needed after that study. We aimed to compare the clinical efficacy of emergent sigmoidoscopy and colonoscopy with bowel preparation in overt LGIB

Methods:

Patients who visited emergency department (ED) presenting overt LGIB between January 2011 and May 2016 were retrospectively reviewed. Emergent sigmoidoscopy with/without enema was performed within 12 hours after ED visit and total colonoscopy with bowel preparation using PEG solution was performed when definite bleeding focus was not found in sigmoidoscopy for examination for proximal colon is required.

Results:

A total of 119 patients with LGIB were analyzed. Mean age was 62.8 years and 43.7% was male. 79 (66.4%) patients underwent emergent sigmoidoscopy and 96 (80.7%) patients underwent colonoscopy. Clinically significant bleeding foci were confirmed in 98 patients (77%), and infectious/ischemic colitis (21.8%) and colonic ulcer (20.2%) were common etiology. There was significant difference in detection rate for clinically significant lesion between emergent sigmoidoscopy and colonoscopy (27.8% vs. 65.2%, p= 0.024). In 47 patients without significant lesion in sigmoidoscopy, 29 (61.7%) patients showed significant lesion in subsequent colonoscopy.

Conclusions:

Emergent sigmoidoscopy with/without enema showed low detection rate and commonly needed to perform subsequent colonoscopy with bowel preparation in LGIB. Therefore, in overt LGIB patients, emergent sigmoidoscopy without bowel preparation as the first diagnostic tool could be omitted for cost-effectiveness.