Risk factors associated with the need for colonoscopic hemostasis for acute lower gastrointestinal bleeding.

Background and purpose: Colonoscopy is an essential diagnostic and therapeutic tool for lower gastrointestinal bleeding (LGIB), with colonoscopic hemostasis needed in a subset of patients. We aim to identify risk factors associated with colonoscopic hemostasis requirement in acute LGIB patients.

Methods: This retrospective study examined consecutive patients who underwent colonoscopy for acute LGIB at a single tertiary hospital between November 2020 and May 2023. Clinical and laboratory profiles were compared between acute LGIB patients who did and did not require colonoscopic hemostasis. Risk factors for hemostasis were determined using regression analysis.

Results: The study cohort included 409 acute LGIB patients. The most common cause of acute LGIB among the 212 patients with overt bleeding was inflammatory lesions (n = 120; 56.60 %), followed by neoplastic (n = 38; 17.92 %) and vascular lesions (n = 26; 12.26 %). Hypotension was significantly more common among patients with overt bleeding than those without (11.32 % vs. 1.52 %; P = 0.0001). Patients who required colonoscopic hemostasis (n = 53) had a significantly lower hemoglobin level (9.3 vs. 10.0 g/dL; P = 0.039), higher rate of red blood cell transfusion (52.83 % vs. 36.52 %; P = 0.023), and more significant hypotension (18.87 % vs. 4.78 %; P = 0.0001) compared to those who did not. Significant hypotension was an independent risk factor for colonoscopic hemostasis (adjusted odds ratio, 3.64; 95 % confidence interval, 1.43-9.30; P = 0.007).

Conclusions: Acute LGIB patients with significant hypotension are at higher risk of requiring colonoscopic hemostasis and may benefit from early colonoscopic evaluation.