volume 116 issue 11 pages 2222-2234

Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study

Naoyoshi Nagata 1
Katsumasa Kobayashi 2
Atsushi Yamauchi 3
Atsuo Yamada 4
Jun Omori 5, 6, 7, 8
Takashi Ikeya 9
Taiki Aoyama 10
Naoyuki Tominaga 11
Yoshinori Sato 12
Takaaki Kishino 13
Naoki Ishii 14
Masaki Murata 16
Akinari Takao 17
Kazuhiro Mizukami 18
Ken Kinjo 19
Shunji Fujimori 20
Takahiro Uotani 21
MINORU FUJITA 22
Hiroki Sato 23
Sho Suzuki 24
Toshiaki Narasaka 25
Junnosuke Hayasaka 26
Tomohiro Funabiki 27
Yuzuru Kinjo 28
Akira Mizuki 29
Shu Kiyotoki 30
Tatsuya Mikami 31
Ryosuke Gushima 32, 33, 34, 35, 36
Hiroyuki FUJII 37
Yuta Fuyuno 38
Naohiko Gunji 39
Yosuke Toya 40
Kazuyuki Narimatsu 41
Koji Nagaike 43
Tetsu Kinjo 44
Yorinobu Sumida 45
Sadahiro Funakoshi 46
Kana Kawagishi 47
Tamotsu Matsuhashi 48
Yuga Komaki 49
Kuniko Miki 50
Kazuhiro Watanabe 51
Masakatsu Fukuzawa 52
Takao Itoi 52
Naomi Uemura 53
Takashi Kawai 50
Mitsuru Kaise 5, 6, 7, 8
2
 
Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
5
 
Department of Gastroenterology
7
 
Graduate School of Medicine
8
 
Tokyo Japan
10
 
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
11
 
Department of Gastroenterology Saga Medical Center Koseikan Saga Japan
13
 
Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
14
 
Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
21
 
Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, 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.
32
 
Department of Gastroenterology and Hepatology
33
 
Graduate School of Medical Sciences
35
 
Kumamoto
36
 
JAPAN
37
 
Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.
43
 
Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan.
44
 
Department of Endoscopy, University of the Ryukyu Hospital, Okinawa, Japan.
45
 
Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Publication typeJournal Article
Publication date2021-08-13
scimago Q1
wos Q1
SJR2.344
CiteScore10.3
Impact factor7.6
ISSN00029270, 15720241
Gastroenterology
Hepatology
Abstract
The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia.This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia.Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability.This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging.
Found 
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GOST Copy
Nagata N. et al. Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study // American Journal of Gastroenterology. 2021. Vol. 116. No. 11. pp. 2222-2234.
GOST all authors (up to 50) Copy
Nagata N. et al. Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study // American Journal of Gastroenterology. 2021. Vol. 116. No. 11. pp. 2222-2234.
RIS |
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RIS Copy
TY - JOUR
DO - 10.14309/ajg.0000000000001413
UR - https://doi.org/10.14309/ajg.0000000000001413
TI - Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study
T2 - American Journal of Gastroenterology
AU - Nagata, Naoyoshi
AU - Kobayashi, Katsumasa
AU - Yamauchi, Atsushi
AU - Yamada, Atsuo
AU - Omori, Jun
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 - Gunji, Naohiko
AU - Toya, Yosuke
AU - Narimatsu, Kazuyuki
AU - Manabe, Noriaki
AU - Nagaike, Koji
AU - Kinjo, Tetsu
AU - Sumida, Yorinobu
AU - Funakoshi, Sadahiro
AU - Kawagishi, Kana
AU - Matsuhashi, Tamotsu
AU - Komaki, Yuga
AU - Miki, Kuniko
AU - Watanabe, Kazuhiro
AU - Fukuzawa, Masakatsu
AU - Itoi, Takao
AU - Uemura, Naomi
AU - Kawai, Takashi
AU - Kaise, Mitsuru
PY - 2021
DA - 2021/08/13
PB - Ovid Technologies (Wolters Kluwer Health)
SP - 2222-2234
IS - 11
VL - 116
PMID - 34388140
SN - 0002-9270
SN - 1572-0241
ER -
BibTex |
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@article{2021_Nagata,
author = {Naoyoshi Nagata and Katsumasa Kobayashi and Atsushi Yamauchi and Atsuo Yamada and Jun Omori 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 Naohiko Gunji and Yosuke Toya and Kazuyuki Narimatsu and Noriaki Manabe and Koji Nagaike and Tetsu Kinjo and Yorinobu Sumida and Sadahiro Funakoshi and Kana Kawagishi and Tamotsu Matsuhashi and Yuga Komaki and Kuniko Miki and Kazuhiro Watanabe and Masakatsu Fukuzawa and Takao Itoi and Naomi Uemura and Takashi Kawai and Mitsuru Kaise and others},
title = {Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study},
journal = {American Journal of Gastroenterology},
year = {2021},
volume = {116},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
month = {aug},
url = {https://doi.org/10.14309/ajg.0000000000001413},
number = {11},
pages = {2222--2234},
doi = {10.14309/ajg.0000000000001413}
}
MLA
Cite this
MLA Copy
Nagata, Naoyoshi, et al. “Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study.” American Journal of Gastroenterology, vol. 116, no. 11, Aug. 2021, pp. 2222-2234. https://doi.org/10.14309/ajg.0000000000001413.