FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2621822118> ?p ?o ?g. }

• W2621822118 endingPage "119" @default.
• W2621822118 startingPage "118" @default.
• W2621822118 abstract "The recent American College of Gastroenterology recommendations on the treatment of patients presenting with acute lower GI bleeding,1Strate L.L. Gralnek I.M. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 755Crossref PubMed Scopus (55) Google Scholar which complement earlier recommendations put out by the American Society for Gastrointestinal Endoscopy,2Davila R.E. Rajan E. Adler D. et al.ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer.Gastrointest Endosc. 2005; 61: 1-7Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar have provided an impetus for a more objective review of existing evidence in this area. Although some of the recommendations with regard to initial resuscitation, and to hemoglobin and international normalized ratio thresholds allowing for subsequent colonoscopy, stem from the literature on upper GI bleeding,3Barkun A.N. Bardou M. Kuipers E.J. et al.International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.Ann Intern Med. 2010; 152: 101-113Crossref PubMed Scopus (886) Google Scholar many are specific to the target population of interest and justify the timely publication of the systematic review and meta-analysis by Kouanda et al.4Kouanda A.M. Somsouk M. Sewell J.L. et al.Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis.Gastrointest Endosc. 2017; 86 (107-17.e1)Abstract Full Text Full Text PDF Scopus (49) Google Scholar A discussion about the presented results is especially important, considering the disparate body of low-quality evidence they are based on.1Strate L.L. Gralnek I.M. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 755Crossref PubMed Scopus (55) Google Scholar Although many aspects of the methodology adopted by the group are appropriate and state of the art, and are adapted to the stated objective of the review, some fall short and require closer perusal because of their inferences concerning patient treatment, especially because their conclusions appear not to be completely congruent with existing guidelines as to the clinical benefits and role of early colonoscopy. The authors identified 12 studies, including 2 (older) randomized controlled trials (RCTs). Two comparative arm studies5Niikura 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-e30Crossref PubMed Scopus (45) Google Scholar, 6Strate L.L. Syngal S. Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding.Am J Gastroenterol. 2003; 98: 317-322PubMed Google Scholar identified by another meta-analysis published with similar objectives previously presented in abstract form7Afshar I.R. Sadr M.S. Martel M. et al.The role of colonoscopy within 24 hours of presentation for acute lower gastrointestinal bleeding (ALGIB): a systematic review [abstract].Gastrointest Endosc. 2015; 81: AB369Abstract Full Text Full Text PDF Google Scholar were not included for unspecified reasons. Omitting some studies may lead to bias in determining summary results. The grading of the quality of the evidence is also critical in providing as transparent an estimate of effect as possible, and at the very least to indicate to readers the confidence with which the summary data can be interpreted. Here too, even though the authors rated individual studies appropriately, they did not provide a formal assessment of the body of evidence for each of the studied outcomes, such as that recommended by use of the Grading of Recommendations, Assessment, Development, and Evaluation methodology, as was done in the American College of Gastroenterology guidelines. Granted, the authors did infer some hierarchic classification of evidence based on the different study designs, but even in this case they appear to have misinterpreted one of the key studies that in fact used a historical control group, not a prospectively gathered contemporary group, to match the cohort undergoing early colonoscopy.8Jensen D.M. Machicado G.A. Jutabha R. et al.Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.N Engl J Med. 2000; 342: 78-82Crossref PubMed Scopus (529) Google Scholar Furthermore, the decision to include the matched propensity analysis study by Nagata et al9Nagata N. Niikura R. Sakurai T. et al.Safety and effectiveness of early colonoscopy in management of acute lower gastrointestinal bleeding on the basis of propensity score matching analysis.Clin Gastroenterol Hepatol. 2016; 14: 558-564Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar in a subgroup analysis with RCT data in the subgroup analysis can also be questioned, because this statistical approach decreases but does not remove possible confounding.10Rubin D.B. Estimating causal effects from large data sets using propensity scores.Ann Intern Med. 1997; 127: 757-763Crossref PubMed Google Scholar These are important methodological considerations in any attempt to identify the source of the observed statistical heterogeneity that limits the strength of the result inferences—again, especially if these are somewhat incongruent with society recommendations. These shortcomings may explain in part the surprising finding that therapeutic interventions are increased by the performance of early colonoscopy, without however noting enhanced bleeding source localization, in contradistinction to another published meta-analysis that found significantly heightened rates in both these outcomes in both overall and RCT subgroup analyses.7Afshar I.R. Sadr M.S. Martel M. et al.The role of colonoscopy within 24 hours of presentation for acute lower gastrointestinal bleeding (ALGIB): a systematic review [abstract].Gastrointest Endosc. 2015; 81: AB369Abstract Full Text Full Text PDF Google Scholar Granted, the subjectivity and variability in determining the pertinence of endoscopic findings and the resulting benefits of endoscopic therapy are real issues, especially in lower GI bleeding. Additional reasons for this surprising discrepancy are that the authors compared patients undergoing early colonoscopy with some control individuals not having had a colonoscopy, and they also classified as endoscopic therapy the performance of hemorrhoidal band ligation—a choice that many endoscopists would not consider a pertinent category. No statistical difference remained in the subgroup analysis comparing early with later colonoscopy. The lack of improvement in usual bleeding clinical outcomes, including rebleeding, need for surgery, and all causes of bleeding-related mortality, was previously noted in society guidelines1Strate L.L. Gralnek I.M. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 755Crossref PubMed Scopus (55) Google Scholar, 2Davila R.E. Rajan E. Adler D. et al.ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer.Gastrointest Endosc. 2005; 61: 1-7Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar and is confirmed by the current meta-analysis. The benefits of performing therapeutic hemostasis with resultant lowered rebleeding has been suggested by Jensen et al,8Jensen D.M. Machicado G.A. Jutabha R. et al.Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.N Engl J Med. 2000; 342: 78-82Crossref PubMed Scopus (529) Google Scholar emulating the high-risk stigmata and therapeutic intervention reported in nonvariceal upper GI bleeding.3Barkun A.N. Bardou M. Kuipers E.J. et al.International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.Ann Intern Med. 2010; 152: 101-113Crossref PubMed Scopus (886) Google Scholar However, observational data in the lower GI tract are limited to a few patients, with large confidence intervals characterizing hierarchical outcomes.8Jensen D.M. Machicado G.A. Jutabha R. et al.Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.N Engl J Med. 2000; 342: 78-82Crossref PubMed Scopus (529) Google Scholar Notwithstanding these realizations, the recommendation favoring early colonoscopy is based on the inference that even though it is not clear whether urgent colonoscopy improves important clinical outcomes such as rebleeding, because diagnostic yield is improved with early colonoscopy, the lack of a significant benefit in existing studies may reflect inadequate statistical power or insufficient endoscopic therapy.9Nagata N. Niikura R. Sakurai T. et al.Safety and effectiveness of early colonoscopy in management of acute lower gastrointestinal bleeding on the basis of propensity score matching analysis.Clin Gastroenterol Hepatol. 2016; 14: 558-564Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar The shortened duration of hospital stays most likely explains the lower costs attributable to early colonoscopy, even though, here too, RCT-derived data are critical to ensure true between-group comparability (especially for such subjective outcomes), with neither RCT demonstrating a significant decrease in length of stay in contradistinction to retrospective studies.1Strate L.L. Gralnek I.M. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 755Crossref PubMed Scopus (55) Google Scholar The observed feasibility and safety is reassuring and is in keeping with large observational studies—an important congruity when we consider the low incidence of such outcomes. So what is a clinician to conclude about the results of this meta-analysis and findings that are seemingly discrepant with existing recommendations? Kouanda et al4Kouanda A.M. Somsouk M. Sewell J.L. et al.Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis.Gastrointest Endosc. 2017; 86 (107-17.e1)Abstract Full Text Full Text PDF Scopus (49) Google Scholar have provided an honest effort at summarizing what is a heterogeneous and sparse body of overall low-quality to very low-quality literature. The analysis is limited by interpretation of study designs and clinically important outcome categorization, and by the choice of subgroup analyses with findings that are less congruent with another meta-analysis, reported only in abstract form to date.1Strate L.L. Gralnek I.M. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 755Crossref PubMed Scopus (55) Google Scholar The conclusion of this latter meta-analysis is more in keeping with existing recommendations, having focused on subgrouping of RCT information, even if these are older studies, and on the increased lesional detection attributable to early colonoscopy. Perhaps the most important take-home message for readers is one that applies to most meta-analyses, especially in digestive endoscopy: that the conclusions are limited by the quality and abundance of available data. Formal assessment of the body of evidence related to a given outcome should ideally be provided with meta-analyses in such a manner as to allow optimal and adapted interpretation of the presented results. Additional high-quality comparative data are sorely needed to more definitively convince skeptics, with, it is hoped, a demonstration of improved clinical outcomes such as rebleeding. Perhaps most importantly, the aforementioned limitations in available data should deter endoscopists from proceeding with a colonoscopy within the first 24 hours after admission if there remain concerns about adequate stabilization or individual safety or feasibility related to a patient’s comorbidities, availability of resources, and endoscopic expertise. All authors disclosed no financial relationships relevant to this publication. Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysisGastrointestinal EndoscopyVol. 86Issue 1PreviewLower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. Full-Text PDF" @default.
• W2621822118 created "2017-06-15" @default.
• W2621822118 creator A5025156152 @default.
• W2621822118 creator A5052819185 @default.
• W2621822118 date "2017-07-01" @default.
• W2621822118 modified "2023-09-23" @default.
• W2621822118 title "The role of early colonoscopy in acute lower GI bleeding: summarizing conflicting data in the presence of society recommendations" @default.
• W2621822118 cites W2017344626 @default.
• W2621822118 cites W2029785398 @default.
• W2621822118 cites W2035771859 @default.
• W2621822118 cites W2052806549 @default.
• W2621822118 cites W2108699935 @default.
• W2621822118 cites W2109525960 @default.
• W2621822118 cites W2288957919 @default.
• W2621822118 cites W2319710449 @default.
• W2621822118 cites W2324634082 @default.
• W2621822118 cites W2583993983 @default.
• W2621822118 doi "https://doi.org/10.1016/j.gie.2017.03.005" @default.
• W2621822118 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/28610853" @default.
• W2621822118 hasPublicationYear "2017" @default.
• W2621822118 type Work @default.
• W2621822118 sameAs 2621822118 @default.
• W2621822118 citedByCount "3" @default.
• W2621822118 countsByYear W26218221182018 @default.
• W2621822118 countsByYear W26218221182019 @default.
• W2621822118 crossrefType "journal-article" @default.
• W2621822118 hasAuthorship W2621822118A5025156152 @default.
• W2621822118 hasAuthorship W2621822118A5052819185 @default.
• W2621822118 hasBestOaLocation W26218221181 @default.
• W2621822118 hasConcept C121608353 @default.
• W2621822118 hasConcept C126322002 @default.
• W2621822118 hasConcept C177713679 @default.
• W2621822118 hasConcept C2778435480 @default.
• W2621822118 hasConcept C526805850 @default.
• W2621822118 hasConcept C61434518 @default.
• W2621822118 hasConcept C71924100 @default.
• W2621822118 hasConcept C90924648 @default.
• W2621822118 hasConceptScore W2621822118C121608353 @default.
• W2621822118 hasConceptScore W2621822118C126322002 @default.
• W2621822118 hasConceptScore W2621822118C177713679 @default.
• W2621822118 hasConceptScore W2621822118C2778435480 @default.
• W2621822118 hasConceptScore W2621822118C526805850 @default.
• W2621822118 hasConceptScore W2621822118C61434518 @default.
• W2621822118 hasConceptScore W2621822118C71924100 @default.
• W2621822118 hasConceptScore W2621822118C90924648 @default.
• W2621822118 hasIssue "1" @default.
• W2621822118 hasLocation W26218221181 @default.
• W2621822118 hasLocation W26218221182 @default.
• W2621822118 hasOpenAccess W2621822118 @default.
• W2621822118 hasPrimaryLocation W26218221181 @default.
• W2621822118 hasRelatedWork W2004700394 @default.
• W2621822118 hasRelatedWork W2069858699 @default.
• W2621822118 hasRelatedWork W2086392903 @default.
• W2621822118 hasRelatedWork W2129431772 @default.
• W2621822118 hasRelatedWork W2170272972 @default.
• W2621822118 hasRelatedWork W2371709010 @default.
• W2621822118 hasRelatedWork W2387459474 @default.
• W2621822118 hasRelatedWork W2425239049 @default.
• W2621822118 hasRelatedWork W3020811650 @default.
• W2621822118 hasRelatedWork W4252403173 @default.
• W2621822118 hasVolume "86" @default.
• W2621822118 isParatext "false" @default.
• W2621822118 isRetracted "false" @default.
• W2621822118 magId "2621822118" @default.
• W2621822118 workType "article" @default.