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

5 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

Fingerprint

Observational Studies
Hemorrhage
Colonoscopy
Endoscopic Hemostasis
Diverticulum
Chronic Renal Insufficiency
Observation

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wada, M., Kato, M., Hirai, Y., Kubosawa, Y., Sunata, Y., Abe, K., ... Uraoka, T. (Accepted/In press). Initial Management of Colonic Diverticular Bleeding: Observational Study. Digestion, 41-47. https://doi.org/10.1159/000487264

Initial Management of Colonic Diverticular Bleeding : Observational Study. / Wada, Michiko; Kato, Motohiko; Hirai, Yuichiro; Kubosawa, Yoko; Sunata, Yukie; Abe, Keiichiro; Hirata, Tetsu; Takada, Yoshiaki; Banno, Shigeo; Takatori, Yusaku; Kinoshita, Satoshi; Mori, Hideki; Takabayashi, Kaoru; Kikuchi, Miho; Kikuchi, Masahiro; Suzuki, Masayuki; Kanai, Takanori; Uraoka, Toshio.

In: Digestion, 19.04.2018, p. 41-47.

Research output: Contribution to journalArticle

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 2018, 'Initial Management of Colonic Diverticular Bleeding: Observational Study', Digestion, pp. 41-47. https://doi.org/10.1159/000487264
Wada M, Kato M, Hirai Y, Kubosawa Y, Sunata Y, Abe K et al. Initial Management of Colonic Diverticular Bleeding: Observational Study. Digestion. 2018 Apr 19;41-47. https://doi.org/10.1159/000487264
Wada, Michiko ; Kato, Motohiko ; Hirai, Yuichiro ; Kubosawa, Yoko ; Sunata, Yukie ; Abe, Keiichiro ; Hirata, Tetsu ; Takada, Yoshiaki ; Banno, Shigeo ; Takatori, Yusaku ; Kinoshita, Satoshi ; Mori, Hideki ; Takabayashi, Kaoru ; Kikuchi, Miho ; Kikuchi, Masahiro ; Suzuki, Masayuki ; Kanai, Takanori ; Uraoka, Toshio. / Initial Management of Colonic Diverticular Bleeding : Observational Study. In: Digestion. 2018 ; pp. 41-47.
@article{a2efd4f0c3a5471ebebfea0642bdf18f,
title = "Initial Management of Colonic Diverticular Bleeding: Observational Study",
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.",
keywords = "Colon, Colonic diverticular bleeding, Colonoscopy, Computed tomography, Endoscopy, Lower gastrointestinal bleeding, Re-bleeding, Risk factors",
author = "Michiko Wada and Motohiko Kato and Yuichiro Hirai and Yoko Kubosawa and Yukie Sunata and Keiichiro Abe and Tetsu Hirata and Yoshiaki Takada and Shigeo Banno and Yusaku Takatori and Satoshi Kinoshita and Hideki Mori and Kaoru Takabayashi and Miho Kikuchi and Masahiro Kikuchi and Masayuki Suzuki and Takanori Kanai and Toshio Uraoka",
year = "2018",
month = "4",
day = "19",
doi = "10.1159/000487264",
language = "English",
pages = "41--47",
journal = "Digestion",
issn = "0012-2823",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Initial Management of Colonic Diverticular Bleeding

T2 - Observational Study

AU - Wada, Michiko

AU - Kato, Motohiko

AU - Hirai, Yuichiro

AU - Kubosawa, Yoko

AU - Sunata, Yukie

AU - Abe, Keiichiro

AU - Hirata, Tetsu

AU - Takada, Yoshiaki

AU - Banno, Shigeo

AU - Takatori, Yusaku

AU - Kinoshita, Satoshi

AU - Mori, Hideki

AU - Takabayashi, Kaoru

AU - Kikuchi, Miho

AU - Kikuchi, Masahiro

AU - Suzuki, Masayuki

AU - Kanai, Takanori

AU - Uraoka, Toshio

PY - 2018/4/19

Y1 - 2018/4/19

N2 - 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.

AB - 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.

KW - Colon

KW - Colonic diverticular bleeding

KW - Colonoscopy

KW - Computed tomography

KW - Endoscopy

KW - Lower gastrointestinal bleeding

KW - Re-bleeding

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85045761384&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045761384&partnerID=8YFLogxK

U2 - 10.1159/000487264

DO - 10.1159/000487264

M3 - Article

SP - 41

EP - 47

JO - Digestion

JF - Digestion

SN - 0012-2823

ER -