Gastrointestinal Hemorrhage
Conditions
Keywords
Colonoscopy, Gastrointestinal bleeding
Brief summary
Study hypothesis is that performing early colonoscopy in patients who present to the hospital with lower GI bleeding improves their outcome. Patients who are admitted with bleeding from their rectum and a negative endoscopic exam of the stomach and upper intestine are randomized (like flipping a coin) to receive a colonsoscopy either as an emergency (within 12 hours) or as a routine procedure (36 hours after admission). Patients are followed during their hospitalization to see if they have further bleeding, if they require blood transfusions, if they need other diagnostic tests, if they need surgery or other treatments, and how long they stay in the hospital.
Detailed description
The aim of this study is to determine if performing early colonoscopy in patients who present to the hospital with lower GI bleeding improves their outcome. Patients who are admitted with bleeding from their rectum and clinical evidence of a significant bleeding episode (elevated heart rate, low blood pressure, or need for blood transfusion) have immediate upper endoscopy (examination of the stomach with a flexible rubber tube with a light and video camera on the end). If this shows no source of bleeding, the patients are randomized (like flipping a coin) to receive a colonsoscopy (examination of the large intestine with a flexible rubber tube with a light and video camera on the end) either as a emergency (within 12 hours) or as a routine procedure (36 hours after admission). Patients are followed during their hospitalization to see if they have further bleeding, if they require blood transfusions, if they need other diagnostic tests, if they need surgery or other treatments, and how long they stay in the hospital.
Interventions
PROCEDUREEarly colonoscopy
Colonoscopy within 12 hours of presentation
PROCEDUREElective colonoscopy
Colonoscopy 36-60 hours after presentation
Sponsors
University of Southern California
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients who are admitted with rectal bleeding and one of the following high-risk features: 1. HR \> 100/min 2. Systolic blood pressure \<100 mmHg 3. Orthostasis -considered as increase in HR by\> 20/min on assuming erect position as well as by decrease by 20 mmHg in systolic blood pressure 4. Need for blood transfusion 5. Drop in hemoglobin \> 1.5 g/dl or in hematocrit of \> 6% in 6 hours
Exclusion criteria
1. Inability to give informed consent 2. Peritoneal signs 3. Severe co-morbidities that would preclude the use of colonoscopy in standard clinical practice
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Further bleeding | Duration of hospitalization (randomization to date of discharge from hospital) |
Secondary
| Measure | Time frame |
|---|---|
| Diagnostic yield | Duration of hospitalization (randomization to date of discharge from hospital) |
Countries
United States
Outcome results
None listed