{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:29:21Z","timestamp":1788244161352,"version":"build-2803163510"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"name":"the Advanced Research and Development Programs for Medical Innovation (PRIME) from AMED"},{"name":"P-CREATE from AMED"},{"DOI":"10.13039\/501100004330","name":"Smoking Research Foundation","doi-asserted-by":"crossref","award":["http:\/\/dx.doi.org\/10.13039\/501100004330"],"award-info":[{"award-number":["http:\/\/dx.doi.org\/10.13039\/501100004330"]}],"id":[{"id":"10.13039\/501100004330","id-type":"DOI","asserted-by":"crossref"}]},{"name":"JSPS KAKENHI Grant","award":["20K08366"],"award-info":[{"award-number":["20K08366"]}]},{"name":"Grants-in-Aid for Research from the National Center for Global Health and Medicine","award":["19A-2015"],"award-info":[{"award-number":["19A-2015"]}]},{"DOI":"10.13039\/100007449","name":"Takeda Science Foundation","doi-asserted-by":"crossref","award":["http:\/\/dx.doi.org\/10.13039\/100007449"],"award-info":[{"award-number":["http:\/\/dx.doi.org\/10.13039\/100007449"]}],"id":[{"id":"10.13039\/100007449","id-type":"DOI","asserted-by":"crossref"}]},{"name":"KAKENHI Grants-in-Aid for Scientific Research from JSPS"},{"name":"the Ministry of Health, Labour and Welfare, Japan","award":["19HB1003"],"award-info":[{"award-number":["19HB1003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>\n            Background\u2002The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy.<\/jats:p><jats:p>\n            Methods\u2002We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6\u200a% received endoscopic treatment.<\/jats:p><jats:p>\n            Results\u200230-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5\u200a% vs. right colon 28.6\u200a%) and etiologies (diverticular bleeding 27.5\u200a% vs. others [e.\u200ag. ulcerative lesions or angioectasia] 8.9\u200a%), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95\u200a%CI 0.49\u20130.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95\u200a%CI 0.29\u20130.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95\u200a%CI 0.41\u20130.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. <\/jats:p><jats:p>\n            Conclusions\u2002A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.<\/jats:p>","DOI":"10.1055\/a-2232-9630","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T23:59:53Z","timestamp":1707955193000},"page":"291-301","source":"Crossref","is-referenced-by-count":13,"title":["High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan"],"prefix":"10.1055","volume":"56","author":[{"given":"Tomonori","family":"Aoki","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoyoshi","family":"Nagata","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan"},{"name":"Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Sadashima","sequence":"additional","affiliation":[{"name":"Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7692-0557","authenticated-orcid":false,"given":"Katsumasa","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7670-0359","authenticated-orcid":false,"given":"Atsushi","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuo","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Omori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ikeya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St. Luke's International University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiki","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoyuki","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Kishino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4876-1063","authenticated-orcid":false,"given":"Naoki","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsunaki","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Nagoya University Hospital, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinari","family":"Takao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Mizukami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Oita University, Oita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kinjo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Fujimori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Uotani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Fujita","sequence":"additional","affiliation":[{"name":"Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-3724","authenticated-orcid":false,"given":"Hiroki","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoku","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4074-1140","authenticated-orcid":false,"given":"Mitsuhiro","family":"Fujishiro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, 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