Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Tsutomu Nishida; Ryota Niikura; Naoyoshi Nagata; Tetsuro Honda; Hajime Sunagozaka; Yasutoshi Shiratori; Shigetsugu Tsuji; Tetsuya Sumiyoshi; Tomoki Fujita; Shu Kiyotoki; Tomoyuki Yada; Katsumi Yamamoto; Tomohiro Shinozaki; Dai Nakamatsu; Atsuo Yamada; Mitsuhiro Fujishiro

doi:10.1055/a-1464-0809

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(06): E943-E954
DOI: 10.1055/a-1464-0809

Original article

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Tsutomu Nishida

¹Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan

,

Ryota Niikura

²Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

³Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan

,

Naoyoshi Nagata

³Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan

⁴Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan

,

Tetsuro Honda

⁵Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki-shi, Nagasaki, Japan

,

Hajime Sunagozaka

⁶Department of Gastroenterology, Fukui Prefectural Hospital, Fukui-shi, Fukui, Japan

,

Yasutoshi Shiratori

⁷Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan

,

Shigetsugu Tsuji

⁸Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Ishikawa, Japan

,

Tetsuya Sumiyoshi

⁹Department of Gastroenterology, Tonan Hospital, Sapporo-shi, Hokkaido, Japan

,

Tomoki Fujita

¹⁰Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru-shi, Hokkaido, Japan

¹¹Department of Gastroenterology, Sapporo Century Hospital, Sapporo-shi, Hokkaido, Japan

,

Shu Kiyotoki

¹²Department of Gastroenterology, Shuto General Hospital, Yanai-shi, Yamaguchi, Japan

,

Tomoyuki Yada

¹³Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Ichikawa-shi, Chiba, Japan

,

Katsumi Yamamoto

¹⁴Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka-shi, Osaka, Japan

,

Tomohiro Shinozaki

¹⁵Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan

,

Dai Nakamatsu

¹Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan

,

Atsuo Yamada

²Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Mitsuhiro Fujishiro

¹⁶Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya-shi, Aichi, Japan

› Author Affiliations

Abstract

Background and study aims It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB.

Patients and methods We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality.

Results Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % P = 0.0914).

Conclusions The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB.

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References

References
1 Niikura R, Nagata N, Aoki T. et al. Predictors for identification of stigmata of recent hemorrhage on colonic diverticula in lower gastrointestinal bleeding. J Clin Gastroenterol 2015; 49: e24-30
2 Walsh CM, Umar SB. ASGE Training Committee,. et al. Colonoscopy core curriculum. Gastrointest Endosc 2020; 93: 297-304
3 Niikura R, Nagata N, Yamada A. et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology 2020; 158: 168-175 e166
4 Niikura R, Nagata N, Yamada A. et al. A multicenter, randomized controlled trial comparing the identification rate of stigmata of recent hemorrhage and rebleeding rate between early and elective colonoscopy in outpatient-onset acute lower gastrointestinal bleeding: study protocol for a randomized controlled trial. Trials 2018; 19: 214
5 Aronchick CA. Bowel preparation scale. Gastrointest Endosc 2004; 60: 1037-1038 ; author reply 1038–1039
6 Niikura R, Nagata N, Doyama H. et al. Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study. World J Gastrointest Endosc 2016; 8: 785-794
7 Gostout CJ, Wang KK, Ahlquist DA. et al. Acute gastrointestinal bleeding. Experience of a specialized management team. J Clin Gastroenterol 1992; 14: 260-267
8 Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204: 530-536
9 Gayer C, Chino A, Lucas C. et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery 2009; 146: 600-606 ; discussion 606–607
10 Urabe M, Nishida T, Shimakoshi H. et al. Distinct clinical factors in hospitalized patients with diverticular bleeding and diverticulitis. Digestion 2019; 99: 239-246
11 Patel SG, Keswani R, Elta G. et al. Status of competency-based medical education in endoscopy training: a nationwide survey of US ACGME-accredited gastroenterology training programs. Am J Gastroenterol 2015; 110: 956-962
12 Lam AY, Li Y, Gregory DL. et al. Association between improved adenoma detection rate and interval colorectal cancer rates after a quality improvement program. Gastrointest Endosc 2020; 92: 355-364.e5
13 Nagata N, Niikura R, Aoki T. et al. Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage. World J Gastroenterol 2015; 21: 10697-10703