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 f
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American Society for Gastrointestinal Endoscopy