LAUSR

Perhaps the most important take-home message for readers is one that applies to most meta-analyses, especially in digestive endoscopy: that the conclusions are limited by the quality and abundance of available data. The recent American College of Gastroenterology recommendations on the treatment of patients presenting with acute lower GI bleeding, which complement earlier recommendations put out by the American Society for Gastrointestinal Endoscopy, have provided an impetus for a more objective review of existing evidence in this area. Although some of the recommendations with regard to initial resuscitation, and to hemoglobin and international normalized ratio thresholds allowing for subsequent colonoscopy, stem from the literature on upper GI bleeding, many are specific to the target population of interest and justify the timely publication of the systematic review and meta-analysis by Kouanda et al. A discussion about the presented results is especially important, considering the disparate body of low-quality evidence they are based on. Although many aspects of the methodology adopted by the group are appropriate and state of the art, and are adapted to the stated objective of the review, some fall short and require closer perusal because of their inferences concerning patient treatment, especially because their conclusions appear not to be completely congruent with existing guidelines as to the clinical benefits and role of early colonoscopy. The authors identified 12 studies, including 2 (older) randomized controlled trials (RCTs). Two comparative arm studies identified by another meta-analysis published with similar objectives previously presented in abstract form were not included for unspecified reasons. Omitting some studies may lead to bias in determining summary results. The grading of the quality of the evidence is also critical in providing as transparent an estimate of effect as possible, and at the very least to indicate to readers the confidence with which the summary data can be interpreted. Here too, even though the authors rated individual studies appropriately, they did not provide a formal assessment of the body of evidence for each of the studied outcomes, such as that recommended by use of the Grading of Recommendations, Assessment, Development, and Evaluation methodology, as was done