P0612 - Utility of Repeating Colonoscopy for Evaluation of Lower Gastrointestinal Bleeding in Patients Who Have Had Prior Colonoscopy

Akash Keluth Chavan, MD¹, Akash Khurana, MD², Anita Mahadevan, MD³, Khushbu Patel, MD⁴, Bilal Ali, MD¹, Adrian S. Lindsey, MD⁵, Amitabh Chak, MD^6
1University Hospitals Cleveland Medical Center, Cleveland, OH; ²Case Western Reserve University, University Hospitals, Cleveland, OH; ³Case Western Reserve University School of Medicine, Cleveland, OH; ⁴Case Western Reserve/UHCMC, Cleveland, OH; ⁵CWRU/UH/VA, Cleveland, OH; ⁶Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH

Introduction: Diagnostic colonoscopy performed in most patients hospitalized with lower gastrointestinal bleeding (LGIB) affects outcome when an advanced colonic neoplasia is discovered or a therapeutic intervention is performed. We sought to determine how often performing repeat colonoscopy in patients with LGIB who had a previous colonoscopy affects outcome.

Methods: We performed a single institution retrospective cohort study for patients that underwent inpatient evaluation for LGIB with colonoscopy between 4/1/2016 and 8/31/2021. Patients were identified through the Provation endoscopy software using procedure indications of hematochezia, melena or rectal bleeding and were eligible if the procedure was performed as an inpatient. Patients were excluded if their most recent colonoscopy was greater than 5 years prior and if they had a colonoscopy finding of post-polypectomy ulcer. Patients were divided into two groups based on if their prior colonoscopy was within 5 years or if they never had a colonoscopy prior to the presentation for LGIB. We collected basic laboratory data, indication for endoscopy, findings on endoscopy, use of hemostatic interventions (argon plasma coagulation, epinephrine injection, endoclip placement).

Results: A total of 245 patients met inclusion criteria. 84 (34.2%) patients had a colonoscopy within 5 years prior to their presentation (group 1) and 161 (65.8%) patients did not have records of a prior colonoscopy (group 2). 41 patients (group 1: 12, group 2: 29) had no findings reported on colonoscopy and 100 patients (group 1: 34, group 2: 66) had findings other than diverticulosis and/or hemorrhoids, most commonly polyps (Table 1). 11.4% of group 2 had a polypectomy compared to 21.5% of group 1 (OR 2.13, 95% CI 0.92-4.91). All 7 patients with a new diagnosis of colon cancer were in group 2. Hemostatic interventions such as APC or epinephrine injection also tended to be less likely in group 1 (OR 0.46, CI 0.20-1.10).

Discussion: Advanced colonic neoplasia is unlikely in patients who present with LGIB if they have had a colonoscopy in the previous 5 years. These patients also have lower rates of hemostatic intervention. The utility of repeat colonoscopy may be limited in patients who have had a colonoscopy in the previous five years when they present with LGIB.



Disclosures:


Akash Keluth Chavan, MD¹, Akash Khurana, MD², Anita Mahadevan, MD³, Khushbu Patel, MD⁴, Bilal Ali, MD¹, Adrian S. Lindsey, MD⁵, Amitabh Chak, MD⁶. P0612 - Utility of Repeating Colonoscopy for Evaluation of Lower Gastrointestinal Bleeding in Patients Who Have Had Prior Colonoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.