Intervention Versus Observation in Patients Presenting With Lower Gastrointestinal Bleeding

Background and Aims: Lower gastrointestinal bleeding (LGIB) is a common cause of hospitalization; incidence increases with age. Current diagnostic modalities for LGIB are invasive and bleeding often stops spontaneously. Some patients are managed supportively, but there is limited recent data on observation alone. This study compares outcomes for patients admitted with LGIB undergoing diagnostic intervention compared with observation and medical management only. Methods: A retrospective comparison of patients admitted to a large academic hospital with initial presentation of LGIB between January 2010 and August 2018. Interventions included CT angiography with or without embolization, flexible sigmoidoscopy, colonoscopy, capsule endoscopy, EGD, or surgery. Primary outcome was 30-day readmission; secondary were blood transfusions, length of stay (LOS), and ICU stay. Initial proportions were compared using Chi-square with a t-test for continuous data. Regression models with propensity adjustment was then used to control for confounders. A P-value of < 0.05 was considered significant. Results: Of 344 patients presenting with LGIB, 263 underwent intervention and 81 were managed with supportive care. Regression models found no significant difference in 30-day readmission rate, LOS, or inpatient rebleeding. Intervention was associated with ICU stay (OR = 0.5, CL 0.28, 0.92, but not blood transfusion (OR 0.6, CL 0.32, 1.13). Only 24% of interventions resulted in hemostatic therapy. Conclusion: In patients admitted for LGIB with similar rates of comorbidities and hemodynamics on presentation, no difference was seen in the rate of re-bleeding or re-admission for patients undergoing more intensive care with radiologic and/or endoscopic interventions despite adjustment for confounding. A prospective trial comparing observation with supportive management for lower GI bleeding is warranted.