Acute Lower GI Bleeding: Risk Factors for Re-admission and Inpatient Endoscopic Necessity

【Aim】This study evaluated the necessity and impact of inpatient lower gastrointestinal (LGI) endoscopy in acute lower gastrointestinal bleeding (ALGIB) after stabilization. We also assessed factors associated with 6-month readmission using propensity score matching (PSM).【Methods】A retrospective review of ALGIB admissions at a tertiary center (2014－2018) included adults (≧18 years), excluding those unfit for colonoscopy. The primary outcome was 6-month readmission. PSM balanced baseline characteristics between patients who underwent LGI endoscopy and those who did not.【Results】Of 567 patients with per rectal (PR) bleeding, 120 (21.2%) underwent inpatient LGI endoscopy. Readmission occurred in 57 (10.1%) patients. Readmission was higher in those undergoing LGI endoscopy, especially with antiplatelets/anticoagulants (20% vs. 11%, p=0.046). However, LGI endoscopy was not an independent risk factor (OR 1.523, p=0.108). Antiplatelet/anticoagulant use (OR 2.444, p=0.005) and angiographic embolization (OR 4.060, p=0.003) were strongest predictors. Before PSM, LGI endoscopy patients had higher transfusion (p=0.002) and CT angiography rates (p=0.020). After PSM, no significant difference in readmission was found (p=0.306). The diagnostic yield of colonoscopy was 36%, with 19% undergoing treatment. Flexible sigmoidoscopy had a lower yield.【Conclusion】Inpatient LGI endoscopy did not reduce readmission and was performed in higher-risk patients. PSM supported no association with readmission reduction.