Melena is the passage of dark tarry stools containing decomposing blood that usually indicates bleeding in the upper part of the alimentary canal.
This new study, the largest to-date to examine the diagnostic yield of colonoscopy to investigate melena after a nondiagnostic upper endoscopy in patients from a broad geographic distribution and a variety of clinical practice settings, found a diagnostic yield of 4.8 percent for colonoscopy in patients with melena.
Previous, small studies found a relatively high rate of finding sources of bleeding — diagnostic yields of 23-35 percent for colonoscopy in this patient population.
“We performed this study to describe the diagnostic yield and rate of therapeutic intervention of colonoscopy in this patient population and compare the diagnostic yield with a control population of average-risk patients having screening colonoscopies,” said study lead author Jason P. Etzel, MD, Oregon Health and Science University, Portland, in the release. “We hypothesized that the diagnostic yield of colonoscopy in this clinical setting is lower than previously described but higher than that of average-risk screening patients and that the rate of therapeutic intervention during colonoscopy in patients with melena and a nondiagnostic upper endoscopy is low. Our results showed an overall low rate, 4.8 percent, of locating a bleeding source on colonoscopy. In addition, the rate of therapeutic intervention during colonoscopy for bleeding was very low at 1.7 percent, suggesting that the majority of these procedures are diagnostic only and could be performed on an elective basis.”
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