Navigation Links
Diagnostic yield of colonoscopy for melena after nondiagnostic upper endoscopy is lower than previously reported
Date:4/17/2012

OAK BROOK, Ill. April 17, 2012 A new study from researchers in Oregon reports that the diagnostic yield of colonoscopy to investigate melena after a nondiagnostic upper endoscopy is lower, 4.8 percent, than previously reported. The rate of therapeutic intervention in this population is very low; therefore, patients with melena and a nondiagnostic upper endoscopy who are stable and without evidence of ongoing bleeding may be able to safely undergo elective colonoscopy. This study is the largest to-date to examine the diagnostic yield of colonoscopy to investigate melena after a nondiagnostic upper endoscopy in patients from a broad geographic distribution and a variety of clinical practice settings. The study appears in the April issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Melena is the passage of dark tarry stools containing decomposing blood that is usually an indication of bleeding in the upper part of the alimentary canal. The alimentary canal is a long tube made up of the esophagus, stomach, small intestine, and large intestine into which food is taken and digested and from which wastes are passed out of the body. Melena is most frequently caused by an upper gastrointestinal (GI) bleeding source, however, upper endoscopy can be nondiagnostic for a specific source of bleeding in approximately one-fourth of cases in this patient population. It is known that blood in the cecum (the beginning of the large intestine) can also result in melena, demonstrating that lower GI bleeding sources can cause melena. Consequently, colonoscopy is frequently performed in patients with melena after a nondiagnostic upper endoscopy in order to exclude a lower GI source of the melena.

Previous studies on the diagnostic yield of colonoscopy in patients with melena described a relatively high rate of finding sources of bleeding. These small studies found diagnostic yields of 23 percent to 35 percent for colonoscopy in this patient population.

"We performed this study to describe the diagnostic yield and rate of therapeutic intervention of colonoscopy in this patient population and compare the diagnostic yield with a control population of average-risk patients having screening colonoscopies. We hypothesized that the diagnostic yield of colonoscopy in this clinical setting is lower than previously described but higher than that of average-risk screening patients and that the rate of therapeutic intervention during colonoscopy in patients with melena and a nondiagnostic upper endoscopy is low," said study lead author Jason P. Etzel, MD, Oregon Health and Science University, Portland. "Our results showed an overall low rate, 4.8 percent, of locating a bleeding source on colonoscopy. In addition, the rate of therapeutic intervention during colonoscopy for bleeding was very low at 1.7 percent, suggesting that the majority of these procedures are diagnostic only and could be performed on an elective basis."

Methods

This was a retrospective case-control study that involved patients in the Clinical Outcomes Research Initiative (CORI) database with a colonoscopy performed to investigate melena within 30 days of a nondiagnostic upper endoscopy for the same indication. A control group had colonoscopies performed for average-risk screening. The CORI database is an endoscopic database that collects data from community, academic, and Veterans Affairs settings across a broad geographic area in the United States. Main outcome measurements were the endoscopic finding of a suspected bleeding source, defined as right-sided arteriovenous malformation, colitis, polyp ≥ 20 mm, tumor, or ulcer, as well as the rate of therapeutic intervention during colonoscopy.

Results

A total of 1,743 colonoscopies were performed to evaluate melena after a nondiagnostic upper endoscopy for the same indication. The melena population included more individuals with advanced age, more men, higher American Society of Anesthesiologists (ASA) Physical Status Classification System scores, and more warfarin use than average-risk screening controls. Melena-related colonoscopies were more likely to be conducted on inpatients, have lower quality bowel preparation, and have fellow involvement than colonoscopies on controls. Colonoscopy was performed the same day as upper endoscopy in 59 percent of cases.

All of the anticipated sources of suspected bleeding were more prevalent in patients with melena, except for polyps ≥ 20 mm in the right side of the colon. The overall rate of finding a suspected lower GI bleeding source in patients with melena was 4.76 percent compared with 1.28 percent in the control population. Notably, colon tumors were nearly three times more likely in the patients with melena than the average risk screening control group. The overall rate of endoscopic therapy in the population with melena was low, with therapy being performed in 1.7 percent of melena-related colonoscopies.

The researchers concluded that the diagnostic yield of colonoscopy to investigate melena after a nondiagnostic upper endoscopy is lower than previously reported. Moreover, the rate of therapeutic intervention in this population is very low; therefore, patients with melena and a nondiagnostic upper endoscopy who are stable and without evidence of ongoing bleeding may be able to safely undergo elective colonoscopy. Colonoscopy remains useful in this group of patients as they are at increased risk of colorectal cancer. The decision on timing of colonoscopy must be made based on an assessment of the overall clinical context.


'/>"/>

Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

Related medicine news :

1. New Diagnostic Guidelines for Mental Illnesses Proposed
2. MRI: Non-invasive diagnostic tool for diagnosing testicular cancer
3. Damaged protein identified as early diagnostic biomarker for Alzheimers disease in healthy adults
4. Health Diagnostic Laboratory Inc. (HDL, Inc.) Launches Community Initiative, It Starts with the Heart
5. Ziosoft Expands PhyzAiodynamic Diagnostic Solutions into Greek Healthcare Market
6. Use and costs of diagnostic imaging increasing for patients with cancer
7. New Diagnostic Testing Company, Blue Ocean Biomedical, Specializes In Automated, Load & Go Cell Analysis Systems For Immune Monitoring
8. ELLKAY Introduces Revolutionary Live Insurance Mapping Solution for Diagnostic Laboratories
9. More Than Half of Pediatricians Make Diagnostic Errors: Survey
10. Diagnostic blood test can identify rare lung disease
11. Flagship Biosciences Partners with a Leading IHC CLIA Laboratory for Companion Diagnostics Service
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:3/27/2017)... ... March 27, 2017 , ... Mt. Angel Vitamins, a 5-year-old ... rebranding effort. This includes the introduction of new packaging and messaging, as well ... we learned that a simple, proactive approach to wellness is important to vitamin ...
(Date:3/27/2017)... RICHEY, Fla. (PRWEB) , ... March 27, 2017 ... ... drug overdose deaths soared 167%,(1) with opioids alone responsible for over 33,000 of ... Kevin McCarty has sponsored Assembly Bill (AB) 1512, which proposes a tax on ...
(Date:3/26/2017)... Ohio (PRWEB) , ... March 26, 2017 , ... ... doctors worldwide to receive the RealSelf 100 Award, a prestigious award honoring the ... cosmetic procedures and to find and connect with doctors and clinics. , In ...
(Date:3/24/2017)... ... 2017 , ... Clean Earth, Inc., a leader in providing ... materials announced today the acquisition of privately owned AERC Recycling Solutions ... facilities and a vast array of additional technologies, services, and new markets to ...
(Date:3/24/2017)... ... 24, 2017 , ... Infectious disease affects billions of people ... States, it’s a threat that is constantly changing and evolving. Mediaplanet's “Fighting Infection” ... strategies for the healthcare community to help decrease the number of completely preventable ...
Breaking Medicine News(10 mins):
(Date:3/24/2017)... , Mar. 24, 2017 Research and Markets ... Business Report" report to their offering. ... This report analyzes the worldwide markets for Dental Implants ... Canada , Japan , ... , and Rest of World. Annual estimates and ...
(Date:3/24/2017)... 2017 Research and Markets has announced the addition ... report to their offering. ... The IPF pipeline is very strong with a total of 97 drug ... Biogen and Sanofi are involved in the development of the IPF therapeutics. ... in Phase III stage, 15 are in Phase II stage, 12 are ...
(Date:3/24/2017)... , Mar 24, 2017 Research and Markets ... Global Strategic Business Report" report to their offering. ... The report provides separate comprehensive analytics for ... Europe , Asia-Pacific , ... are provided for the period 2015 through 2022. Also, a six-year historic ...
Breaking Medicine Technology: