Early Endoscopy Is Associated with Better Clinical Outcomes in Patients Hospitalized with Ischemic Bowel Disease

  • Olalekan AkanbiEmail author
  • Adeyinka Charles Adejumo
Original Article


Background and Aims

Providing diagnostic and therapeutic interventions, lower gastrointestinal endoscopy is a salient investigative modality for ischemic bowel disease (IB). As studies on the role of endoscopic timing on the outcomes of IB are lacking, we sought to clarify this association.


After identifying 18-to-90-year-old patients with a primary diagnosis of IB from the 2012–2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we grouped them based on timing of endoscopy into three: early (n = 9268), late (n = 3515), and no endoscopy (n = 18,452). We explored the determinants of receiving early endoscopy, the impact of endoscopic timing on outcomes (mortality and 13 others), and the impact of the type of endoscopy (colonoscopy vs. sigmoidoscopy) on these outcomes among the early group (SAS 9.4).


Less likely to receive early endoscopy were Blacks compared to Whites (adjusted odds ratio [aOR] 0.81 95% CI [0.70–0.94]), and individuals on Medicaid, Medicare, and uninsured compared to the privately insured group (aOR 0.80 [0.71–0.91], 0.70 [0.58–0.84], and 0.68 [0.56–0.83]). Compared to the late and no endoscopy groups, patients with early endoscopy had less mortality (aOR 0.53 [0.35–0.80] and 0.09 [0.07–0.12]), shorter length of stay (LOS, 4.64 [4.43–4.87] days vs. 8.87 [8.40–9.37] and 6.62 [6.52–7.13] days), lower total hospital cost (THC, $41,055 [$37,995–$44,361] vs. $72,598 [$66,768–$78,937] and $68,737 [$64,028–$73,793]), and better outcomes. Similarly, among those who received early endoscopy, colonoscopy had better outcomes than sigmoidoscopy for mortality, THC, LOS, and adverse events.


Early endoscopy, especially colonoscopy, is associated with better clinical outcomes and decreased healthcare utilization in IB. Unfortunately, there are disparities against Blacks, and non-privately insured individuals in receiving early endoscopy.


Endoscopy Ischemic bowel disease Health outcomes Mortality Cost Length of stay 



Early endoscopy


Late endoscopy


No endoscopy


Ischemic bowel disease


Ischemic colitis


Acute kidney injury


Length of stay


Total hospital cost


Total parenteral nutrition


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2019_5598_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)


  1. 1.
    Silva JA, White CJ. Ischemic bowel syndromes. Prim Care. 2013;40:153–167.CrossRefGoogle Scholar
  2. 2.
    Greenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:445–473.CrossRefGoogle Scholar
  3. 3.
    Yadav S, Dave M, Varayil JE, et al. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol. 2015;13:731.e1–6–738.e1–6. (quiz e41).CrossRefGoogle Scholar
  4. 4.
    Montoro MA, Brandt LJ, Santolaria S, et al. Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study). Scand J Gastroenterol. 2011;46:236–246.CrossRefGoogle Scholar
  5. 5.
    Higgins PDR, Davis KJ, Laine L. The epidemiology of ischaemic colitis. Aliment Pharmacol Ther. 2004;19:729–738.CrossRefGoogle Scholar
  6. 6.
    Ghassemi KA, Jensen DM. Lower GI bleeding: epidemiology and management. Curr Gastroenterol Rep. 2013. Scholar
  7. 7.
    Moss AJ, Tuffaha H, Malik A. Lower GI bleeding: a review of current management, controversies and advances. Int J Colorectal Dis. 2016;31:175–188.CrossRefGoogle Scholar
  8. 8.
    Sreenarasimhaiah J. Diagnosis and management of ischemic colitis. Curr Gastroenterol Rep. 2005;7:421–426.CrossRefGoogle Scholar
  9. 9.
    Baixauli J, Kiran RP, Delaney CP. Investigation and management of ischemic colitis. Cleve Clin J Med. 2003;70:920–921, 925–926, 928–930 passim.Google Scholar
  10. 10.
    Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ, American College of Gastroenterology. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015;110:18–44. (quiz 45).CrossRefGoogle Scholar
  11. 11.
    Cole JA, Cook SF, Sands BE, Ajene AN, Miller DP, Walker AM. Occurrence of colon ischemia in relation to irritable bowel syndrome. Am J Gastroenterol. 2004;99:486–491.CrossRefGoogle Scholar
  12. 12.
    Chang L, Kahler KH, Sarawate C, Quimbo R, Kralstein J. Assessment of potential risk factors associated with ischaemic colitis. Neurogastroenterol Motil. 2008;20:36–42.Google Scholar
  13. 13.
    Obi K, Hinton A, Sobotka L, et al. Early sigmoidoscopy or colonoscopy is associated with improved hospital outcomes in ulcerative colitis-related hospitalization. Clin Transl Gastroenterol. 2016;7:e203.CrossRefGoogle Scholar
  14. 14.
    Akanbi O, Adejumo AC, Saleem N, Francisque F, Soliman M, Ogunbayo GO. Sickle cell disease is associated with higher mortality among patients hospitalized with ischemic bowel disease. Eur J Gastroenterol Hepatol. 2018;30:1027–1032.CrossRefGoogle Scholar
  15. 15.
    Adejumo AC, Akanbi O, Pani L. Among inpatients, ischemic bowel disease predisposes to Clostridium difficile infection with concomitant higher mortality and worse outcomes. Eur J Gastroenterol Hepatol. 2019;31:109–115.CrossRefGoogle Scholar
  16. 16.
    Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139.CrossRefGoogle Scholar
  17. 17.
    Hale JJ, Thompson DM, Darden PM. Calculating subset weighted analysis using PROC SURVEYFREQ and GENMOD. Accessed 23 Dec 2017.
  18. 18.
    HCUP Methods Series Calculating National Inpatient Sample (NIS) Variances for Data Years 2012 and Later. Accessed 21 Dec 2017.
  19. 19.
    Chavalitdhamrong D, Jensen DM, Kovacs TOG, et al. Ischemic colitis is a common cause of severe hematochezia and patient outcomes are worse than with other colonic diagnoses. Gastrointest Endosc. 2011;74:852–857.CrossRefGoogle Scholar
  20. 20.
    Feuerstadt P, Brandt LJ. Update on colon ischemia: recent insights and advances. Curr Gastroenterol Rep. 2015;17:45.CrossRefGoogle Scholar
  21. 21.
    Theodoropoulou Α, Κoutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol WJG. 2008;14:7302–7308.CrossRefGoogle Scholar
  22. 22.
    Brandt LJ, Feuerstadt P, Blaszka MC. Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol. 2010;105:2245–2252. (quiz 2253).CrossRefGoogle Scholar
  23. 23.
    Cho JH, Kim KO, Jung YW, Kim DI, Lee SH, Jang BI. Clinical outcomes in ischemic colitis: according to the colonoscopic extent and feature. Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi. 2012;60:19–25.CrossRefGoogle Scholar
  24. 24.
    Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin N Am. 1992;72:203–229.CrossRefGoogle Scholar
  25. 25.
    Weissman J, Russell D, Jay M, Malaspina D. Racial, ethnic, and gender disparities in health care access and use among U.S. adults with serious psychological distress. Psychiatr Serv. 2018;69:517–522.CrossRefGoogle Scholar
  26. 26.
    Kao J, Vicuna R, House JA, Rumsfeld JS, Ting HH, Spertus JA. Disparity in drug-eluting stent utilization by insurance type. Am Heart J. 2008;156:1133–1140.CrossRefGoogle Scholar
  27. 27.
    Gao S, Kumar RG, Wisniewski SR, Fabio A. Disparities in health care utilization of adults with traumatic brain injuries are related to insurance, race, and ethnicity: a systematic review. J Head Trauma Rehabil. 2018;33:E40–E50.CrossRefGoogle Scholar
  28. 28.
    Manuel JI. Racial/ethnic and gender disparities in health care use and access. Health Serv Res. 2018;53:1407–1429.CrossRefGoogle Scholar
  29. 29.
    O’Neill S, Yalamarthi S. Systematic review of the management of ischaemic colitis. Colorectal Dis. 2012;14:e751–e763.CrossRefGoogle Scholar
  30. 30.
    Genstorfer J, Schäfer J, Kettelhack C, Oertli D, Rosenthal R. Surgery for ischemic colitis: outcome and risk factors for in-hospital mortality. Int J Colorectal Dis. 2014;29:493–503.CrossRefGoogle Scholar
  31. 31.
    Ryoo S-B, Oh H-K, Ha H-K, Moon SH, Choe EK, Park KJ. The outcomes and prognostic factors of surgical treatment for ischemic colitis: what can we do for a better outcome? Hepatogastroenterology. 2014;61:336–342.Google Scholar
  32. 32.
    Sadler MD, Ravindran NC, Hubbard J et al. Predictors of mortality among patients undergoing colectomy for ischemic colitis: a population-based United States study. Can J Gastroenterol Hepatol. 2014;28:600–604.CrossRefGoogle Scholar
  33. 33.
    Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012;25:228–235.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Hospital Medicine, Department of MedicineUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.Department of MedicineNorth Shore Medical CenterSalemUSA
  3. 3.Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations