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Objectives Lower gastrointestinal bleeding is a common presentation with little data concerning risk factors for adverse outcomes. The aim was to derive and validate a scoring system to stratify risk in lower gastrointestinal bleeding and compare it to the Oakland score. Methods A total of 2385 consecutive patients (mean age 65 years, 1140 males) were used to derive the score using multivariate logistic regression modeling then internally and externally validated. The Oakland score was applied and area under receiver operating characteristic (AUROC) curves were calculated and compared. A score of <1 was compared with an Oakland score of <9 to assess 30‐day rebleeding and mortality rates. Results Rebleeding was associated with age, inpatient bleeding, syncope, malignancy, tachycardia, hypotension, lower hemoglobin and mortality with age, inpatient bleeding, liver/gastrointestinal disease, tachycardia, and hypotension. The area under the receiver operating characteristic curves was 0.742 for rebleeding and 0.802 for mortality. A score <1 was associated with rebleeding (0.0%–2.2%) and mortality (0%). The Oakland score had a significantly lower area under the receiver operating characteristic curve for rebleeding of 0.687 but not for mortality; 0.757. A score <1 was associated with a lower 30‐day rebleeding risk compared to an Oakland score <9 (4/379 vs. 15/355, p = 0.009) but not mortality (0/365 vs. 1/355, p = 0.493). Conclusions Our score predicts 30‐day rebleeding and mortality rate with low scores associated with very low risk. The Aberdeen score is superior to the Oakland score for predicting rebleeding. Prospective evaluation of both scores is required.

IntroductionThe incidence of ischaemic colitis has risen from 6.1 cases/100 000 person-years in 1976-80 to 22.9/100 000 in 2005-09 (Trotter JM, Hunt L, Peter MB. Ischaemic colitis. BMJ. 2016 Dec 22;355:i6600. doi: 10.1136/bmj.i6600. PMID: 28007701). The mortality rates range in large series range from 4- 12%. Currently there is no specific guidance for treatment of ischaemic colitis. It is managed by general principles of supportive care and antibiotics. Surgery is reserved for patients with gangrenous bowel or perforation. We did retrospective analysis to observe the role of Antiplatelets and Anticoagulants (AA) in ischaemic colitis with a subsequent follow-up of at least 2 years.MethodsRetrospective data analysis for patients admitted with ischaemic colitis in the last 10 years using patient notes, discharge letters and GP records. Patients were divided into 2 groups. Group 1 taking AA and Group 2 used as control arm. Total of 114 patients met inclusion criteria but 34 were excluded due to histology/imaging showing alternate diagnosis leaving 35 patients in Group 1 and 45 in Group 2. Data was collected to compare patient demographics, clinical severity, endoscopic/radiological findings, treatment offered, length of hospital stay and outcomes. The clinical severity index was used from ACG guidelines (A m J Gastroenterol 2015; 110:18–44; doi: 10.1038/ajg.2014.395). Patient records were reviewed for a period of 2 years following discharge to document subsequent morbidity, i.e., readmissions with same condition and mortality.ResultsOur data showed that average age of patients 74 and 66 in Group 1 and 2 respectively. The clinical severity of ischaemic colitis in Group 1 patients was less than in Group 2 patients as shown in Figure 1. 65% of the patients in group 1 had no treatment and were only observed compared to 48% in group 2. Similar trend was seen in antibiotic usage, 34% patients in group 1 received antibiotics compared to 42% in Group 2. None of the patients in Group 1 needed surgery but 7% of the patients in Group 2 did. Average hospital stay was lower in Group 1 of 5.8 days compared to 12.4 days for Group 2. The readmission rate was 1.3% and 6.6% in Group 1 and 2 respectively. Data was not captured appropriately for mortality on acute admission due to missing information but there was no statistically significant difference at 2 years between both groups.ConclusionsOur retrospective data analysis shows that patients not taking antiplatelets or anticoagulants present with ischaemic colitis at a younger age and have adverse clinical course when admitted to hospital. Patients not taking AA tend to have longer hospital admission, higher antibiotic usage, increased likelihood of surgery and more likely to be readmitted in 2 years. This difference was not statistically observed on mortality at 2 years. Further studies are encouraged with higher volume to validate above findings.

BackgroundAccurate optical characterisation and removal of small adenomas (<10 mm) at colonoscopy would allow hyperplastic polyps to be left in situ and surveillance intervals to be determined without the need for histopathology. Although accurate in specialist practice the performance of narrow band imaging (NBI), colonoscopy in routine clinical practice is poorly understood.MethodsNBI-assisted optical diagnosis was compared with reference standard histopathological findings in a prospective, blinded study, which recruited adults undergoing routine colonoscopy in six general hospitals in the UK. Participating colonoscopists (N=28) were trained using the NBI International Colorectal Endoscopic (NICE) classification (relating to colour, vessel structure and surface pattern). By comparing the optical and histological findings in patients with only small polyps, test sensitivity was determined at the patient level using two thresholds: presence of adenoma and need for surveillance. Accuracy of identifying adenomatous polyps <10 mm was compared at the polyp level using hierarchical models, allowing determinants of accuracy to be explored.FindingsOf 1688 patients recruited, 722 (42.8%) had polyps <10 mm with 567 (78.5%) having only polyps <10 mm. Test sensitivity (presence of adenoma, N=499 patients) by NBI optical diagnosis was 83.4% (95% CI 79.6% to 86.9%), significantly less than the 95% sensitivity (p<0.001) this study was powered to detect. Test sensitivity (need for surveillance) was 73.0% (95% CI 66.5% to 79.9%). Analysed at the polyp level, test sensitivity (presence of adenoma, N=1620 polyps) was 76.1% (95% CI 72.8% to 79.1%). In fully adjusted analyses, test sensitivity was 99.4% (95% CI 98.2% to 99.8%) if two or more NICE adenoma characteristics were identified. Neither colonoscopist expertise, confidence in diagnosis nor use of high definition colonoscopy independently improved test accuracy.InterpretationThis large multicentre study demonstrates that NBI optical diagnosis cannot currently be recommended for application in routine clinical practice. Further work is required to evaluate whether variation in test accuracy is related to polyp characteristics or colonoscopist training.Trial registration numberThe study was registered with clinicaltrials.gov (NCT01603927).

IntroductionLower gastrointestinal bleeding (LGIB) is a common and heterogeneous condition. We have previously reported on a prognostic scoring system devised from the Aberdeen cohort and recently another scoring system has been published (The Oakland score) but requires validation.1 Both scoring systems report the ability to identify low risk of rebleeding and mortality at 30 days. This study aimed to compare the two scores particularly with respect to identifying those who may be eligible for safe discharge from a bleeding point of view.MethodsThe Aberdeen bleeding unit database was used (N=2719) to derive and internally and validate our scoring system using the following variables; inpatient status, age, syncope, underlying malignancy, liver disease, blood pressure, pulse rate and haemoglobin. The score was then externally validated in a different region. The Oakland score was then applied to the derivation cohort and receiver operating characteristic (ROC) curves calculated and compared with the Aberdeen score. To determine each scores ability to identify low risk patients, an Aberdeen score of <1 was compared with an Oakland score <9 (both determined a priori) to assess rebleeding and mortality rates at 30 days.ResultsThe derivation cohort of 2385 patients (1140 males) was used to compare the two scores of whom 129 (5.6%) patients died within 30 days, 135 (5.7%) required surgical intervention and 322 (13.5%) experienced re-bleeding. Comparing the two scoring systems with respect to rebleeding showed an area under the ROC curve of 0.742 (0.709 – 0.774) for the Aberdeen score and 0.687 (0.668 – 0.705) for the Oakland score. With respect to mortality the area under the ROC curve was 0.802 (0.755 – 0.848) for the Aberdeen score and 0.757 (0.739 – 0.774) for the Oakland score. An Aberdeen score <1 was associated with a significantly lower 30 day rebleeding risk compared to an Oakland score <9 (4/379 (1.1%) vs. 15/355 (4.2%), p=0.009) but 30 day mortality was similar (0/365 (0.0%) vs. 1/355 (0.3%), p=0.493).ConclusionThe use of these scores may predict who can be safely discharged. The Aberdeen score is easier to calculate on admission and appears to be superior to the Oakland score, particularly for predicting rebleeding.. Prospective evaluation of both scores is required.ReferenceOakland K, Jairath V, Uberoi R, Guy R, Ayaru L, Mortensen N, Murphy MF, Collins GS. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol 2017 Sep;2(9):635–643.