Long-Term Clinical Course after Conservative and Endoscopic Treatment of Colonic Diverticular Bleeding

What naturally happens to patients after they undergo conservative and endoscopic treatment of colonic diverticular bleeding (CDB) is largely unknown. We retrospectively track the long-term outcome of the recurrence of CDB between patients with endoscopic and conservative treatment.

The group was divided into 2 groups: patients treated with injection and/or clipping (endoscopic group) and patients in whom such treatment could not be performed (conservative group). CDB recurrence was assessed via a questionnaire, and recurrence rates were investigated between groups using the Kaplan-Meier's method. The Cox proportional hazards model was performed to identify potential risk factors for recurrence.

Eighty-eight patients answered the questionnaires. The median (interquartile range) follow-up period was 42.7 (61.8) months. Twenty-four (38.7%) of 62 conservatively treated patients and 16 (61.5%) of 26 endoscopically treated patients experienced recurrence of CDB during the follow-up period. Kaplan-Meier's analysis showed that the rate of recurrence was significantly higher (p < 0.05) in cases with endoscopic treatment than in those with conservative treatment (mean time to recurrence = 55.3 months (95% CI 30.8-79.9) vs. 99.9 months (95%CI 80.7-119.1)). The Cox proportional hazards model did not identify any significant variables.

We should carefully follow-up patients to check for the recurrence of CDB, even when it could be successfully treated endoscopically. Can endoscopic treatment of CDB prevent CDB recurrence? Also, what happens to the patient's well-being after they undergo conservative and endoscopic treatment (cases diagnosed by Jensen's criteria) is largely unknown. We examined a population of patients undergoing conservative or endoscopic treatment to clarify the clinical course, particularly with regard to CDB recurrence.