Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study.

"CONFLICTS OF INTEREST Guarantor of the article: Naoyoshi Nagata, MD, PhD. Specific author contributions: N.N.: was the principal investigator of this study. N.N.: designed and conducted the study, interpreted the data, and mainly wrote the article. K.K. (Bokuto hospital), A. Yamauchi, A. Yamada, J.O., T.I., T.A., N.T., Y. Sato, T. Kishino, N.I., T.S., M.M., A.T., K.M., K.K. (Fukuoka University Chikushi Hospital), S. Fujimori, T.U., M.F., H.S., S.S., T.N., J.H., T.F., Y. Kinjo, A.M., S.K., T.M., R.G., H.F., Y.F., N.G., Y.T., K. Narimatsu, N.M., K. Nagaike, T. Kinjo, Y.S., S. Funakoshi, K.K., T.M., Y. Komaki, K.M., K.W., and M.K.: designed the study, made decisions and definitions of survey items, and interpreted the data. N.N. and K.M.: performed the statistical analysis. M.F., T.I., N.U., T. Kinjo, and M.K.: provided corrections and advice on the preparation of the article. Financial support: This work was partially supported by grants from the Ministry of Health, Labour and Welfare, Japan (grant number: 19HB1003), JSPS KAKENHI grant (JP17K09365 and 20K08366), Smoking Research Foundation, Takeda Science Foundation, Tokyo Medical University Cancer Research Foundation, Tokyo Medical University Research Foundation, Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, and 30-1020). The funders played no role in the study design, analysis, and decision to publish the manuscript. Potential competing interests: None to report.Study HighlightsWHAT IS KNOWN✓ Many physicians empirically suspect bleeding etiology based on the presenting symptoms.✓ The precise bleeding source of hematochezia is not known unless colonoscopy is performed.✓ How bleeding sources are identified may affect adverse outcomes, which may trigger changes in management.WHAT IS NEW HERE✓ Colonoscopy had a high diagnostic yield of 95% and identified 48 bleeding etiologies.✓ Differences in outcomes based on bleeding etiology suggest that endoscopy can guide the management of hematochezia.✓ Differentiating between bleeding etiologies based on presenting symptoms and hemodynamic instability alone would be challenging."

"Financial support: This work was partially supported by grants from the Ministry of Health, Labour and Welfare, Japan (grant number: 19HB1003), JSPS KAKENHI grant (JP17K09365 and 20K08366), Smoking Research Foundation, Takeda Science Foundation, Tokyo Medical University Cancer Research Foundation, Tokyo Medical University Research Foundation, Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, and 30-1020). The funders played no role in the study design, analysis, and decision to publish the manuscript."