- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05170945
Early Routine Bowel Preparation for Suspected Acute Diverticular Bleeding
March 30, 2023 updated by: Methodist Health System
Early Routine Bowel Preparation for Suspected Acute Diverticular Bleeding: A Quality Improvement Initiative Analyzing Hospital Length of Stay
This investigation will utilize both a five-year retrospective analysis and a two-year prospective investigation.
Variables including age; gender; presence of anticoagulation medication; hospital length of stay; total transfused red blood cell units; presence of heart failure, chronic kidney disease, or lung disease; history of diverticular disease; whether colonoscopy was performed; if therapeutic hemostasis was performed during colonoscopy; and information regarding prior colonoscopies in the past 10 years will be collected for analysis.
A small number of early bowel preparation patients are expected in the retrospective study; therefore, a prospective study occurring over the next 12 months will be conducted.
Patients agreeing to participate in the study would have a four-liter dose of PEG 3350 ordered, and the medication would be delivered within the first 24 hours of hospitalization.
Radiographic studies including computed tomography angiography, tagged RBC scan, and angiography will not be obtained in the first 24 hours of hospital admission and be considered only if the patient has ongoing hematochezia at the completion of their bowel preparation.
After completion of the 12-month investigative period (or earlier if sufficient sample size is obtained for clinical significance), data will be analyzed for dissemination consideration.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
This investigation will utilize both a five-year retrospective analysis and a two-year prospective investigation.
Patient cohorts and data will be obtained through utilization of the EPIC electronic medical record (EMR) and generating an individualized report to capture all possible patients.
The report will include all admitted patients with a consult note written by the gastroenterology consult service at Methodist Dallas Medical Center.
The consult note will be reviewed, and any patient not meeting the inclusion criteria or those meeting any of the exclusion criteria will be excluded.
The patients remaining after this assessment will be included in the retrospective analysis.
Variables including age; gender; presence of anticoagulation medication; hospital length of stay; total transfused red blood cell units; presence of heart failure, chronic kidney disease, or lung disease; history of diverticular disease; whether colonoscopy was performed; if therapeutic hemostasis was performed during colonoscopy; and information regarding prior colonoscopies in the past 10 years will be collected for analysis.
A small number of early bowel preparation patients are expected in the retrospective study; therefore, a prospective study occurring over the next 12 months will be conducted.
The gastroenterology consult service will assess patients with lower GI bleeding with the inclusion and exclusion criteria.
Those who qualify will be provided informed consent forms and offered the opportunity to enroll in the study.
Patients agreeing to participate in the study would have a four-liter dose of PEG 3350 ordered, and the medication would be delivered within the first 24 hours of hospitalization.
Radiographic studies including computed tomography angiography, tagged RBC scan, and angiography will not be obtained in the first 24 hours of hospital admission and be considered only if the patient has ongoing hematochezia at the completion of their bowel preparation.
The study is not evaluating effects of colonoscopy, and so any additional intervention performed by the attending gastroenterologist will be subject to their own discretion after the completion of the bowel preparation.
After discharge, patient information and data variables will be collected from the EPIC EMR and included in an Excel document.
After completion of the 12-month investigative period (or earlier if sufficient sample size is obtained for clinical significance), data will be analyzed for dissemination consideration.
Disclaimer: Any cost associated with the procedures stated herein will be billed directly to insurance (as applicable).
Study Type
Interventional
Enrollment (Anticipated)
415
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Ashley Haider
- Phone Number: 214 947 1280
- Email: ClinicalResearch@mhd.com
Study Contact Backup
- Name: Colette Ngo Ndjom
- Phone Number: 214 947 1280
- Email: ClinicalResearch@mhd.com
Study Locations
-
-
Texas
-
Dallas, Texas, United States, 75203
- Recruiting
- Methodist Dallas Medical Center
-
Principal Investigator:
- Prashant Kedia, MD
-
Sub-Investigator:
- Bryce Bushe, MD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patient admitted to Methodist Dallas Medical Center
- Age greater than 18 years
- Patient evaluated by gastroenterology consult service during admission
- Hospitalization with diagnosis of "hematochezia", "acute gastrointestinal bleeding", "acute blood loss anemia", or "anemia"
- Endorsed or witnessed episode of painless hematochezia
- Patients exhibiting hemodynamic stability (heart rate <110; systolic blood pressure >90) after initial evaluation and resuscitation by admitting/emergency room physicians
Exclusion Criteria:
- Age less than 18 years
- Persistent hypotension despite initial intravenous fluid resuscitation or fever
- Bowel preparation started 24 hours after initial presentation
- Documented symptoms of dysphagia or odynophagia
- Signs or symptoms suggestive of gastrointestinal obstruction (or ileus) on initial presentation (e.g., abdominal pain, nausea and/or vomiting)
- Inability to complete bowel preparation
- Personal history of inflammatory bowel disease or cirrhosis
- History of immunosuppression (e.g., AIDS, immunosuppressive medication)
- Personal history of colon cancer
- Prior gastric bypass, small bowel, or colonic resection
- Stool culture positive for tested organisms to include Clostridium difficile
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Retrospective Cohort
Colonoscopy was performed, either early bowel preparation, late bowel preparation or no bowel preparation patients.
|
|
Experimental: Prospective Cohort
Early bowel preparation for colonoscopy patients
|
Early (<24 hours) bowel cleansing prior to colonoscopy.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hospital length of stay
Time Frame: 5 years of data will be collected
|
Hospital length of stay in the early bowel preparation, late bowel preparation, and no bowel preparation groups.
|
5 years of data will be collected
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Units of RBC transfused
Time Frame: 5 years of data will be collected
|
The difference in average units of packed red blood cells transfused during the hospital stay between early, late, and no preparation groups.
|
5 years of data will be collected
|
Colonoscopy details
Time Frame: 5 years of data will be collected
|
Whether a colonoscopy was performed during hospitalization, the diagnosis at time of colonoscopy, and presence of anticoagulation medications.
|
5 years of data will be collected
|
Therapeutic Hemostasis Invervention
Time Frame: After discharge
|
• If a colonoscopy was performed, was therapeutic hemostasis intervention performed.
|
After discharge
|
Radiographic Studies
Time Frame: 5 years of data will be collected
|
Number and type of radiographic studies performed to identify source of bleeding.
|
5 years of data will be collected
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Prashant Kedia, MD, Methodist Dallas Medical Center
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 28, 2023
Primary Completion (Anticipated)
May 1, 2024
Study Completion (Anticipated)
May 1, 2024
Study Registration Dates
First Submitted
September 22, 2020
First Submitted That Met QC Criteria
December 9, 2021
First Posted (Actual)
December 28, 2021
Study Record Updates
Last Update Posted (Actual)
March 31, 2023
Last Update Submitted That Met QC Criteria
March 30, 2023
Last Verified
March 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 003.GID.2020.D
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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