Abstract
Aim This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy. Results Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,P=0.690) and recurrent bleeding (22.7% vs. 20.0%, P=0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68–12.0, P < 0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23–7.53, P=0.016). Conclusions In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage.
Highlights
In Japan, the number of patients with colonic diverticulum has been increasing due to aging and the westernization of dietary habits, and the frequency is reportedly about one in four people [1, 2]
In Japanese guidelines for colonic diverticular hemorrhage, it is proposed that early colonoscopy would be preferably performed within 24 hours of hospital visit to identify the stigma of recent hemorrhage (SRH) [6], and several institutions have actively performed early colonoscopy
The rate of SRH identification with early colonoscopy has been still low, only 15%–42% [12,13,14,15,16], due Canadian Journal of Gastroenterology and Hepatology to spontaneous hemostasis during colonoscopy and multiple diverticulum in several cases, which would result in ineffective intervention for colonic diverticular hemorrhage
Summary
In Japan, the number of patients with colonic diverticulum has been increasing due to aging and the westernization of dietary habits, and the frequency is reportedly about one in four people [1, 2]. Along with the elevated number of patients who are taking antithrombotic drugs, the prevalence of colonic diverticular hemorrhage is increasing annually, and this condition is the most frequent cause of lower gastrointestinal bleeding, accounting for approximately 25% of the total cases [3,4,5]. It has been reported that colonic diverticular hemorrhage generally stopped spontaneously, approximately 76%–91% of patients [10, 11]. The rate of SRH identification with early colonoscopy has been still low, only 15%–42% [12,13,14,15,16], due Canadian Journal of Gastroenterology and Hepatology to spontaneous hemostasis during colonoscopy and multiple diverticulum in several cases, which would result in ineffective intervention for colonic diverticular hemorrhage
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