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

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.


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

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