Search

Objectives: Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding; however, the evidence in support for colonic diverticular hemorrhage (CDH) indications remains insufficient. We use a nationwide database to investigate the effectiveness of early colonoscopy for CDH. Methods: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database and identified patients who were admitted for CDH from 2010 to 2017. Patients who underwent colonoscopy on the same day of admission (early group) were compared with those who underwent colonoscopy on the next day of admission (elective group). The primary outcome was in‐hospital mortality, and secondary outcomes were length of hospital stay, total hospitalization cost, fasting period, and the prevalence of re‐colonoscopy, interventional radiology or abdominal surgery. Propensity score matching was used to adjust for confounders. Results: We identified 74,569 eligible patients. Patients were divided into the early (n = 46,759) and elective (n = 27,810) groups. After propensity score matching, 27,696 pairs were generated. In‐hospital mortality did not significantly differ between the two groups (0.49% in the early group vs. 0.41% in the elective group; risk difference 0.08%; 95% confidence interval −0.02 to 0.19; P = 0.14). The early group had a significantly longer length of hospital stay, higher total hospitalization cost, longer fasting period, and higher prevalence of re‐colonoscopy and abdominal surgery. Conclusions: The effectiveness of early colonoscopy conducted on the same day of admission for CDH could not be confirmed. Early colonoscopy may not result in favorable outcomes in CDH patients. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD). Methods: This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies. Results: In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate‐risk (HR 1.63) and high‐risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non‐ESCC‐related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low‐risk, 0; intermediate‐risk, 1–2; and high‐risk, 3–4. The 5‐year non‐ESCC‐related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low‐, intermediate‐, and high‐risk groups, respectively. Meanwhile, the 5‐year ESCC‐specific mortality rates for the pathological low‐, intermediate‐, and high‐risk groups were 0.3%, 5.3%, and 18.2%, respectively. Conclusions: We clarified prognostic factors for patients with pT1a‐MM/pT1b‐SM ESCC after ESD. The combined assessment of non‐ESCC‐ and ESCC‐related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients. [ABSTRACT FROM AUTHOR]