Journal of Gastroenterology

, volume 59 , issue 1 , pages 24-33

Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases

Jun Omori ¹

Mitsuru Kaise ¹

Naoyoshi Nagata ^{2, 3}

Tomonori Aoki ⁴

Katsumasa Kobayashi ⁵

Atsushi Yamauchi ⁶

Atsuo Yamada ⁴

Takashi Ikeya ⁷

Taiki Aoyama ⁸

Naoyuki Tominaga ⁹

Yoshinori Sato ¹⁰

Takaaki Kishino ¹¹

Naoki Ishii ¹²

Tsunaki Sawada ¹³

Masaki Murata ¹⁴

Akinari Takao ¹⁵

Kazuhiro Mizukami ¹⁶

Ken Kinjo ¹⁷

Shunji Fujimori ¹⁸

Takahiro Uotani ¹⁹

Minoru Fujita ²⁰

Hiroki SATO ²¹

Sho Suzuki ²²

Toshiaki Narasaka ^{23, 24}

Junnosuke Hayasaka ²⁵

Tomohiro Funabiki ^{26, 27}

Yuzuru Kinjo ²⁸

Akira Mizuki ²⁹

Shu Kiyotoki ³⁰

Tatsuya Mikami ³¹

Ryosuke Gushima ³²

Hiroyuki FUJII ³³

Yuta Fuyuno ³⁴

Takuto Hikichi ³⁵

Yosuke Toya ³⁶

Kazuyuki Narimatsu ³⁷

Noriaki Manabe ³⁸

Koji Nagaike ³⁹

Tetsu Kinjo ⁴⁰

Yorinobu Sumida ⁴¹

Sadahiro Funakoshi ⁴²

Kiyonori Kobayashi ⁴³

Tamotsu Matsuhashi ⁴⁴

Yuga Komaki ^{45, 46}

Kuniko Miki ²

Kazuhiro Watanabe ³

Katsuhiko Iwakiri ¹

Hide authors affiliations Show authors affiliations: 46 affiliations

Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan |

Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan |

Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan |

⁴

Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan |

⁵

Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan |

⁶

Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan |

⁷

Department of Gastroenterology, St. Luke’s International University, Tokyo, Japan |

⁸

Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan |

⁹

Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan |

¹⁰

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan |

¹¹

Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan |

¹²

Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan |

¹³

Department of Endoscopy, Nagoya University Hospital, Aichi, Japan |

¹⁴

Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan |

¹⁵

Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan |

¹⁶

Department of Gastroenterology, Oita University, Oita, Japan |

¹⁷

Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan |

¹⁸

Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan |

¹⁹

Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan |

²⁰

Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan |

²¹

Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan |

²²

Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan |

²³

Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan |

²⁴

Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan |

²⁵

Department of Gastroenterology, Toranomon hospital, Tokyo, Japan |

²⁶

Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan |

²⁷

Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan |

²⁸

Department of Gastroenterology, Naha City Hospital, Okinawa, Japan |

²⁹

Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan |

³⁰

Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan |

³¹

Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan |

³²

Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan |

³³

Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan |

³⁴

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan |

³⁵

Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan |

³⁶

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan |

³⁷

Department of Internal Medicine, National Defense Medical College, Saitama, Japan |

³⁸

Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan |

³⁹

Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan |

⁴⁰

Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan |

⁴¹

Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan |

⁴²

Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan |

⁴³

Department of Gastroenterology, School of Medicine, Kitasato University, Kanagawa, Japan |

⁴⁴

Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan |

⁴⁵

Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan |

⁴⁶

Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan |

Publication type: Journal Article

Publication date: 2023-11-25

Springer Nature

Journal of Gastroenterology

scimago Q1

wos Q1

SJR: 2.136

CiteScore: 12.1

Impact factor: 5.5

ISSN: 09441174, 14355922

DOI: 10.1007/s00535-023-02057-9

Copy DOI

PubMed ID: 38006444

Gastroenterology

Abstract

Current evidence on the surgical rate, indication, procedure, risk factors, mortality, and postoperative rebleeding for acute lower gastrointestinal bleeding (ALGIB) is limited. We constructed a retrospective cohort of 10,342 patients admitted for acute hematochezia at 49 hospitals (CODE BLUE J-Study) and evaluated clinical data on the surgeries performed. Surgery was performed in 1.3% (136/10342) of the cohort with high rates of colonoscopy (87.7%) and endoscopic hemostasis (26.7%). Indications for surgery included colonic diverticular bleeding (24%), colorectal cancer (22%), and small bowel bleeding (16%). Sixty-four percent of surgeries were for hemostasis for severe refractory bleeding. Postoperative rebleeding rates were 22% in patients with presumptive or obscure preoperative identification of the bleeding source and 12% in those with definitive identification. Thirty-day mortality rates were 1.5% and 0.8% in patients with and without surgery, respectively. Multivariate analysis showed that surgery-related risk factors were transfusion need ≥ 6 units (P < 0.001), in-hospital rebleeding (P < 0.001), small bowel bleeding (P < 0.001), colorectal cancer (P < 0.001), and hemorrhoids (P < 0.001). Endoscopic hemostasis was negatively associated with surgery (P = 0.003). For small bowel bleeding, the surgery rate was significantly lower in patients with endoscopic hemostasis as 2% compared to 12% without endoscopic hemostasis. Our cohort study elucidated the outcomes and risks of the surgery. Extensive exploration including the small bowel to identify the source of bleeding and endoscopic hemostasis may reduce unnecessary surgery and improve the management of ALGIB.

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Omori J. et al. Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases // Journal of Gastroenterology. 2023. Vol. 59. No. 1. pp. 24-33.

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RIS |

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RIS Copy

TY - JOUR

DO - 10.1007/s00535-023-02057-9

UR - https://doi.org/10.1007/s00535-023-02057-9

TI - Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases

T2 - Journal of Gastroenterology

AU - Omori, Jun

AU - Kaise, Mitsuru

AU - Nagata, Naoyoshi

AU - Aoki, Tomonori

AU - Kobayashi, Katsumasa

AU - Yamauchi, Atsushi

AU - Yamada, Atsuo

AU - Ikeya, Takashi

AU - Aoyama, Taiki

AU - Tominaga, Naoyuki

AU - Sato, Yoshinori

AU - Kishino, Takaaki

AU - Ishii, Naoki

AU - Sawada, Tsunaki

AU - Murata, Masaki

AU - Takao, Akinari

AU - Mizukami, Kazuhiro

AU - Kinjo, Ken

AU - Fujimori, Shunji

AU - Uotani, Takahiro

AU - Fujita, Minoru

AU - SATO, Hiroki

AU - Suzuki, Sho

AU - Narasaka, Toshiaki

AU - Hayasaka, Junnosuke

AU - Funabiki, Tomohiro

AU - Kinjo, Yuzuru

AU - Mizuki, Akira

AU - Kiyotoki, Shu

AU - Mikami, Tatsuya

AU - Gushima, Ryosuke

AU - FUJII, Hiroyuki

AU - Fuyuno, Yuta

AU - Hikichi, Takuto

AU - Toya, Yosuke

AU - Narimatsu, Kazuyuki

AU - Manabe, Noriaki

AU - Nagaike, Koji

AU - Kinjo, Tetsu

AU - Sumida, Yorinobu

AU - Funakoshi, Sadahiro

AU - Kobayashi, Kiyonori

AU - Matsuhashi, Tamotsu

AU - Komaki, Yuga

AU - Miki, Kuniko

AU - Watanabe, Kazuhiro

AU - Iwakiri, Katsuhiko

PY - 2023

DA - 2023/11/25

PB - Springer Nature

SP - 24-33

IS - 1

VL - 59

PMID - 38006444

SN - 0944-1174

SN - 1435-5922

ER -

BibTex |

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BibTex (up to 50 authors) Copy

@article{2023_Omori,

author = {Jun Omori and Mitsuru Kaise and Naoyoshi Nagata and Tomonori Aoki and Katsumasa Kobayashi and Atsushi Yamauchi and Atsuo Yamada and Takashi Ikeya and Taiki Aoyama and Naoyuki Tominaga and Yoshinori Sato and Takaaki Kishino and Naoki Ishii and Tsunaki Sawada and Masaki Murata and Akinari Takao and Kazuhiro Mizukami and Ken Kinjo and Shunji Fujimori and Takahiro Uotani and Minoru Fujita and Hiroki SATO and Sho Suzuki and Toshiaki Narasaka and Junnosuke Hayasaka and Tomohiro Funabiki and Yuzuru Kinjo and Akira Mizuki and Shu Kiyotoki and Tatsuya Mikami and Ryosuke Gushima and Hiroyuki FUJII and Yuta Fuyuno and Takuto Hikichi and Yosuke Toya and Kazuyuki Narimatsu and Noriaki Manabe and Koji Nagaike and Tetsu Kinjo and Yorinobu Sumida and Sadahiro Funakoshi and Kiyonori Kobayashi and Tamotsu Matsuhashi and Yuga Komaki and Kuniko Miki and Kazuhiro Watanabe and Katsuhiko Iwakiri and others},

title = {Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases},

journal = {Journal of Gastroenterology},

year = {2023},

volume = {59},

publisher = {Springer Nature},

month = {nov},

url = {https://doi.org/10.1007/s00535-023-02057-9},

number = {1},

pages = {24--33},

doi = {10.1007/s00535-023-02057-9}

}

MLA

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MLA Copy

Omori, Jun, et al. “Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases.” Journal of Gastroenterology, vol. 59, no. 1, Nov. 2023, pp. 24-33. https://doi.org/10.1007/s00535-023-02057-9.

Publisher

Springer Nature

Journal

Journal of Gastroenterology

scimago Q1

wos Q1

SJR

2.136

CiteScore

12.1

Impact factor

5.5

ISSN

09441174 (Print)

14355922 (Electronic)