Trends and Determinants of Inpatient Colonoscopy Use and Timing in Adults Hospitalized with Ischemic Colitis: A National Analysis, 2017-2022.
Reinforcessuggested applicable standard· American College of Gastroenterology (ACG), Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline (Sengupta N, Feuerstein JD, Jairath V, Shergill AK, Strate LL, Wong RJ, Wan D; Am J Gastroenterol 118(2):208-231), 2023
Decision at stakethe timing of inpatient colonoscopy in acute lower gastrointestinal bleeding
… For patients hospitalized with acute LGIB who REQUIRE inpatient colonoscopy, ACG RECOMMENDS a NONEMERGENT inpatient colonoscopy rather than urgent colonoscopy within 24 hours, because urgent colonoscopy within 24h has not been shown to improve rebleeding or mortality (STRONG, moderate-quality); no specific bowel-prep regimen is superior. … After cessation of bleeding, ACG RECOMMENDS resuming anticoagulation, since resumption lowers postbleeding thromboembolism and mortality (STRONG, moderate-quality). …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
Resuscitate and risk-stratify first. ACG 2023 SUGGESTS (conditional, low-quality evidence) using a risk-stratification tool such as the Oakland score to identify low-risk patients with acute LGIB who are appropriate for early discharge and outpatient evaluation, supplementing, not replacing, clinical judgment. Use a restrictive RBC transfusion strategy with a transfusion threshold of hemoglobin 7 g/dL in hemodynamically stable patients (conditional, low-quality); a higher threshold (~8 g/dL) may be considered in known/active cardiovascular disease. For patients with ONGOING HEMODYNAMICALLY SIGNIFICANT hematochezia, ACG SUGGESTS CT angiography as the initial diagnostic test (conditional, low-quality; ~90% sensitivity for source localization, low yield once bleeding is minor or has stopped); if CTA shows extravasation, promptly refer to interventional radiology for transcatheter arteriography and possible embolization (STRONG, moderate-quality). For patients hospitalized with acute LGIB who REQUIRE inpatient colonoscopy, ACG RECOMMENDS a NONEMERGENT inpatient colonoscopy rather than urgent colonoscopy within 24 hours, because urgent colonoscopy within 24h has not been shown to improve rebleeding or mortality (STRONG, moderate-quality); no specific bowel-prep regimen is superior. Reserve reversal agents for LIFE-THREATENING bleeding that does not respond to initial resuscitation (conditional, very-low-quality): for VKA with an INR substantially above therapeutic range, 4-factor PCC is preferred over FFP; for a DOAC taken within the prior 24 hours, use targeted agents (idarucizumab for dabigatran; andexanet alfa for apixaban/rivaroxaban) when available. After cessation of bleeding, ACG RECOMMENDS resuming anticoagulation, since resumption lowers postbleeding thromboembolism and mortality (STRONG, moderate-quality). For antiplatelet therapy after diverticular hemorrhage: CONTINUE aspirin in patients with established cardiovascular disease (secondary prevention; conditional, low-quality), but DISCONTINUE aspirin used for primary cardiovascular prevention (conditional, low-quality).