A Population-based Study of Diverticula: Prevalence, Risk Factors for Bleeding and Treatment Patterns

Abstract

Background/Aims: Endoscopic localization of bleeding diverticula is challenging, and their treatment remains controversial. The aims of this study were to estimate the prevalence of bleeding diverticula identified and treated during colonoscopy, and to determine independent predictors of bleeding using a large endoscopic database. Methods: Patients with diverticula documented during colonoscopy between January 2000 and December 2002 were retrieved from the Clinical Outcomes Research Initiative (CORI) national endoscopic database. The most proximal diverticula were utilized for the analysis of location. Logistic regression with forward selection was used to identify risk factors for active bleeding. Results: Of the 229,727 unique patients undergoing colonoscopy, a total of 56,519 (25%) were found to have diverticulosis. Of patients with diverticulosis, 7% were < 50 yrs of age, 69% were 50-75 yrs, and 23% were > 75 yrs; 58% had an American Association of Anaesthetists (ASA) score of ≥ 2. The distribution of diverticula was documented in 54,068 patients (62%): rectum 1%, sigmoid and descending 83%, transverse 4%, ascending 7%, cecum 5% and entire colon 0.1%. Stigmata of recent or active bleeding were noted in 99 cases (0.2%), of which only 11 (11%) were treated. Location of diverticulosis was available in all patients with bleeding lesions. Independent predictors of active bleeding were (OR, 95% CI): Inpatient status (6.5, 3.9-11), hematochezia (5.6, 3.7-8.5), right-sided lesions (1.9, 1.2-2.9), and increasing age (1.03, 1.01-1.05). Conclusions: Results from this large endoscopic database indicate that actively bleeding diverticula are infrequently identified at the time of endoscopy, and when bleeding is localized, endoscopic therapy is rarely utilized. Although the majority of diverticula are located in the left colon, patients with right-sided diverticula are more likely to have bleeding. Inpatient status, hematochezia and older age are also predictive of active bleeding at endoscopy.