Initial Management of Colonic Diverticular Bleeding: Observational Study

Michiko Wada, Motohiko Kato, Yuichiro Hirai, Yoko Kubosawa, Yukie Sunata, Keiichiro Abe, Tetsu Hirata, Yoshiaki Takada, Shigeo Banno, Yusaku Takatori, Satoshi Kinoshita, Hideki Mori, Kaoru Takabayashi, Miho Kikuchi, Masahiro Kikuchi, Masayuki Suzuki, Takanori Kanai, Toshio Uraoka

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background/Aims: Although colonic diverticular bleeding (CDB) often ceases spontaneously, re-bleeding occurs in about 30%. Bleeding diverticulum can be treated directly by endoscopic hemostasis; however, it is difficult to perform colonoscopy in all cases with limited medical resource and certain risks. The aim of this study was to clarify who should undergo colonoscopy as well as appropriate methods of initial management in CDB patients. Methods: A total of 285 patients who were diagnosed as CDB and underwent colonoscopy from March 2004 to October 2015 were retrospectively analyzed. First, the association between re-bleeding and various factors including patients’ background and initial management were analyzed. Second, the examination conditions that influenced bleeding point identification were analyzed. Results: Of 285 patients, 187 were men and 98 were women. Median age was 75 years, and the median observation period was 17.5 months. Re-bleeding was observed in 79 patients (28%). A history of CDB (OR 2.1, p = 0.0090) and chronic kidney disease (CKD; OR 2.3, p = 0.035) were risk factors, and bleeding point identification (OR 0.20, p = 0.0037) was a preventive factor for re-bleeding. Bleeding point identification significantly reduced approximately 80% of re-bleeding. Furthermore, extravasation on CT (OR 3.7, p = 0.031) and urgent colonoscopy (OR 5.3, p < 0.001) were predictors for identification of bleeding point. Compared to bleeding point identification of 11% in all patients who underwent colonoscopy, identification rate in those who had extravasation on CT and underwent urgent colonoscopy was as high as 70%. Conclusions: Contrast-enhanced CT upon arrival is suggested, and patients with extravasation on CT would be good candidates for urgent colonoscopy, as well as patients who have a history of CDB and CKD.

Original languageEnglish
Pages (from-to)41-47
Number of pages7
JournalDigestion
DOIs
Publication statusAccepted/In press - 2018 Apr 19

Keywords

  • Colon
  • Colonic diverticular bleeding
  • Colonoscopy
  • Computed tomography
  • Endoscopy
  • Lower gastrointestinal bleeding
  • Re-bleeding
  • Risk factors

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Wada, M., Kato, M., Hirai, Y., Kubosawa, Y., Sunata, Y., Abe, K., Hirata, T., Takada, Y., Banno, S., Takatori, Y., Kinoshita, S., Mori, H., Takabayashi, K., Kikuchi, M., Kikuchi, M., Suzuki, M., Kanai, T., & Uraoka, T. (Accepted/In press). Initial Management of Colonic Diverticular Bleeding: Observational Study. Digestion, 41-47. https://doi.org/10.1159/000487264