Initial Management of Colonic Diverticular Bleeding: Observational Study
| Autor: | Michiko Wada, Yoko Kubosawa, Shigeo Banno, Yoshiaki Takada, Satoshi Kinoshita, Kaoru Takabayashi, Yukie Sunata, Masayuki Suzuki, Miho Kikuchi, Motohiko Kato, Tetsu Hirata, Yusaku Takatori, Keiichiro Abe, Takanori Kanai, Hideki Mori, Masahiro Kikuchi, Toshio Uraoka, Yuichiro Hirai |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Lower gastrointestinal bleeding Colon Contrast Media Colonoscopy Diverticulum Colon Identification rate Colonic Diseases 03 medical and health sciences Endoscopic hemostasis 0302 clinical medicine Recurrence Risk Factors medicine Humans Blood Transfusion Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Hemostasis Endoscopic Gastroenterology Middle Aged medicine.disease Extravasation Endoscopy Surgery Treatment Outcome 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Observational study Gastrointestinal Hemorrhage Tomography X-Ray Computed business Extravasation of Diagnostic and Therapeutic Materials Kidney disease |
| Zdroj: | Digestion. 98:41-47 |
| ISSN: | 1421-9867 0012-2823 |
| DOI: | 10.1159/000487264 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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