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Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage?
Takeshi Uehara1, Satohiro Matsumoto1, Hiroyuki Miyatani1
1Department of gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Insights
A new scoring system aids decisions on emergency endoscopy for colonic diverticular hemorrhage. It predicts successful bleeding source identification, improving patient care for this common gastrointestinal bleed.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Clinical Decision Support
Background:
- Colonic diverticular hemorrhage is a frequent cause of acute lower gastrointestinal bleeding.
- Identifying the bleeding source during initial endoscopy is crucial for effective management.
- Predicting successful source identification can optimize the use of emergency endoscopy.
Purpose of the Study:
- To develop and validate a scoring system to aid decision-making for emergency endoscopy in colonic diverticular hemorrhage.
- To identify predictors of successful bleeding source identification during initial endoscopy.
Main Methods:
- Analysis of data from 178 patients with colonic diverticular hemorrhage diagnosed by colonoscopy.
- Division of patients into source-identified and source-not-identified groups based on initial endoscopy findings.
- Development of a scoring system based on multivariate analysis of clinical and imaging predictors.
Main Results:
- Extravasation of contrast medium on CT scans and oral anticoagulant therapy were independent predictors of successful bleeding source identification.
- The developed scoring system demonstrated 80% sensitivity and 81% specificity for predicting successful identification.
- Higher percentages of patients on anticoagulants or with comorbidities were noted in the identified group.
Conclusions:
- A novel scoring system can effectively guide decisions regarding the necessity of emergency endoscopy for colonic diverticular hemorrhage.
- This tool can help clinicians determine the appropriate management strategy for individual patients.
- The scoring system enhances diagnostic yield and resource allocation in managing this condition.
Objective:
We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage.
Methods:
This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source.
Results:
The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy.
Conclusions:
Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage.
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