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Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage
D M Jensen1, G A Machicado, R Jutabha
1Digestive Disease Research Center, University of California at Los Angeles Center for the Health Sciences, and the Veterans Affairs Greater Los Angeles Healthcare System, 90073-1003, USA. djensen@med1.medsch.ucla.edu
Insights
Urgent colonoscopy effectively diagnoses and treats severe lower gastrointestinal bleeding from diverticulosis. Endoscopic therapies like epinephrine injections and bipolar coagulation significantly reduce recurrent bleeding and surgical intervention needs.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Endoscopy
Background:
- The diagnostic and therapeutic role of endoscopy in lower gastrointestinal bleeding (LGIB) due to diverticulosis remains unclear.
- Diverticulosis is a common cause of LGIB, often presenting with significant hematochezia.
Purpose of the Study:
- To evaluate the efficacy of urgent colonoscopy in diagnosing and managing severe hematochezia in patients with diverticulosis.
- To compare surgical outcomes with endoscopic treatment for diverticular hemorrhage.
Main Methods:
- A study involving 121 patients hospitalized for severe hematochezia and diagnosed diverticulosis.
- Urgent colonoscopy was performed within 6-12 hours of admission.
- Treatment strategies evolved from hemicolectomy for persistent bleeding in early patients to endoscopic therapies (epinephrine injection, bipolar coagulation) in later patients.
Main Results:
- Twenty-one to 23 percent of patients had definite signs of diverticular hemorrhage.
- In the later cohort, 10 patients with definite diverticular hemorrhage were successfully treated endoscopically, with no recurrence or need for surgery.
- Endoscopic treatment was effective in managing diverticular bleeding, with 50% of patients having other identified bleeding sources.
Conclusions:
- Urgent colonoscopy is valuable for diagnosing diverticular hemorrhage in patients with severe hematochezia.
- Endoscopic interventions, including epinephrine injections and bipolar coagulation, are effective in treating diverticular bleeding, reducing the need for hemicolectomy.
Background:
Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain.
Methods:
We studied the role of urgent colonoscopy in the diagnosis and treatment of 121 patients with severe hematochezia and diverticulosis. All patients were hospitalized, received blood transfusions as needed, and received a purge to rid the colon of clots, stool, and blood. Colonoscopy was performed within 6 to 12 hours after hospitalization or the diagnosis of hematochezia. Among the first 73 patients, those with continued diverticular bleeding underwent hemicolectomy. For the subsequent 48 patients, those requiring treatment received therapy, such as epinephrine injections or bipolar coagulation, through the colonoscope.
Results:
Of the first 73 patients, 17 (23 percent) had definite signs of diverticular hemorrhage (active bleeding in 6, nonbleeding visible vessels in 4, and adherent clots in 7). Nine of the 17 had additional bleeding after colonoscopy, and 6 of these required hemicolectomy. Of the subsequent 48 patients, 10 (21 percent) had definite signs of diverticular hemorrhage (active bleeding in 5, nonbleeding visible vessels in 2, and adherent clots in 3). An additional 14 patients in this group (29 percent) were presumed to have diverticular bleeding because although they had no stigmata of diverticular hemorrhage, no other source of bleeding was identified. The other 24 patients (50 percent) had other identified sources of bleeding. All 10 patients with definite diverticular hemorrhage were treated endoscopically; none had recurrent bleeding or required surgery.
Conclusions:
Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatment of such patients with epinephrine injections, bipolar coagulation, or both may prevent recurrent bleeding and decrease the need for surgery.
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