Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Tsutomu Nishida; Ryota Nikura; Naoyoshi Nagata; Tetsuro Honda; Hajime Sunagozaka; Yasutoshi Shiratori; Shigetsugu Tsuji; Tetsuya Sumiyoshi; Tomoki Fujita; Shu Kiyotoki; Tomoyuki Yada; Katsumi Yamamoto; Tomohiro Shinozaki; Dai Nakamatsu; Atsuo Yamada; Mitsuhiro Fujishiro

doi:10.1055/a-1464-0809

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Endosc Int Open. 2021 Jun;9(6):E943-E954. doi: 10.1055/a-1464-0809. Epub 2021 May 27.

Authors

Tsutomu Nishida¹, Ryota Nikura^{2

3}, Naoyoshi Nagata^{3

4}, Tetsuro Honda⁵, Hajime Sunagozaka⁶, Yasutoshi Shiratori⁷, Shigetsugu Tsuji⁸, Tetsuya Sumiyoshi⁹, Tomoki Fujita^{10

11}, Shu Kiyotoki¹², Tomoyuki Yada¹³, Katsumi Yamamoto¹⁴, Tomohiro Shinozaki¹⁵, Dai Nakamatsu¹, Atsuo Yamada², Mitsuhiro Fujishiro¹⁶

Affiliations

¹ Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan.
² Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
⁴ Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
⁵ Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki-shi, Nagasaki, Japan.
⁶ Department of Gastroenterology, Fukui Prefectural Hospital, Fukui-shi, Fukui, Japan.
⁷ Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
⁸ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Ishikawa, Japan.
⁹ Department of Gastroenterology, Tonan Hospital, Sapporo-shi, Hokkaido, Japan.
¹⁰ Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru-shi, Hokkaido, Japan.
¹¹ Department of Gastroenterology, Sapporo Century Hospital, Sapporo-shi, Hokkaido, Japan.
¹² Department of Gastroenterology, Shuto General Hospital, Yanai-shi, Yamaguchi, Japan.
¹³ Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Ichikawa-shi, Chiba, Japan.
¹⁴ Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka-shi, Osaka, Japan.
¹⁵ Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
¹⁶ Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya-shi, Aichi, Japan.

Abstract

Background and study aims It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB. Patients and methods We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality. Results Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % P = 0.0914). Conclusions The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).