Acute Lower GI Bleeding: Risk Factors for Readmission and Inpatient Endoscopic Necessity.

Abstract

[Aim]This study evaluated the necessity and impact of inpatient lower gastrointestinal(LGI)endoscopy in acute lower gastrointestinal bleeding(ALGIB)after stabilization. We also assessed factors associated with 6-month readmission using propensity score matching(PSM) [Methods]A retrospective review of ALGIB admissions at a tertiary center(2014-2018)included adults(>=18 years), excluding those unfit for colonoscopy. The primary outcome was 6- month readmission. PSM balanced baseline characteristics between patients who underwent LGI endoscopy and those who did not. [Results]Of 567 patients with per rectal(PR)bleeding, 120(21.2%) underwent inpatient LGI endoscopy. Readmission occurred in 57 (10.1%)patients. Readmission was higher in those undergoing LGI endoscopy, especially with antiplatelets/anticoagulants(20% vs. 11%, p=0.046). However, LGI endoscopy was not an independent risk factor(OR 1.523, p=0.108). Antiplatelet/anticoagulant use(OR 2.444, p=0.005)and angiographic embolization(OR 4.060, p= 0.003)were strongest predictors. Before PSM, LGI endoscopy patients had higher transfusion(p=0.002)and CT angiography rates (p=0.020). After PSM, no significant difference in readmission was found(p=0.306). The diagnostic yield of colonoscopy was 36%, with 19% undergoing treatment. Flexible sigmoidoscopy had a lower yield [Conclusion]Inpatient LGI endoscopy did not reduce readmission and was performed in higher-risk patients. PSM supported no association with readmission reduction.