Comparison of clinical effectiveness of the emergent colonoscopy in patients with hematochezia according to the type of bowel preparation

Background and AimsColonoscopy (CFS) is a valuable diagnostic tool in patients with hematochezia. However, the optimal preparation method of emergent CFS for hematochezia has not been defined. We investigated the clinical effectiveness of bowel preparation of patients with hematochezia using polyethylene glycol (PEG) solution and glycerin or water enemas. MethodsThe medical records of the past 7 years were reviewed. Patients presenting with hematochezia that occurred within 24h before admission were eligible for the study. All patients underwent CFS within 24h after visiting the emergency room for hematochezia. Patients were classified into two groups according to the preparation method used (enema vsPEG). ResultsOverall, 194 patients (125 enema vs 69 PEG) were enrolled. The diagnostic rate of bleeding focus was lower in the enema group than in the PEG group (84% vs 97.1%, P=0.008). Performance of endoscopic hemostasis at the initial CFS was more frequent in the enema group than in the PEG group (40.8% vs 10.1%, P<0.001). The rate of repeated CFS was higher in the enema group than in the PEG group (44.0% vs 18.8%, P<0.001). Post-polypectomy bleeding (n=33) was diagnosed during the initial study and was treated endoscopically. In cases of post-polypectomy bleeding, CFS (93.9%) was performed after an enema in all but two cases. ConclusionsIn hematochezia patients, the PEG group showed a higher diagnostic rate and lower rate of repeated CFS. However, emergent CFS after an enema only seems to be useful in patients with severe hematochezia or if the bleeding focus can be presumed.