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Initial Management of Colonic Diverticular Bleeding: Observational Study

Michiko Wada1,2, Motohiko Kato1, Yuichiro Hirai1

  • 1Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

Digestion
|April 20, 2018
PubMed

Insights

Identifying the source of colonic diverticular bleeding (CDB) is key to preventing re-bleeding. Urgent colonoscopy guided by CT scans can significantly improve outcomes for patients with CDB, especially those with a history of the condition or chronic kidney disease.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Radiology

Background:

  • Colonic diverticular bleeding (CDB) frequently stops spontaneously, but re-bleeding affects approximately 30% of patients.
  • Endoscopic hemostasis offers direct treatment for bleeding diverticula, yet its application is limited by resource constraints and procedural risks.
  • Determining optimal colonoscopy candidates and initial management strategies for CDB is crucial.

Purpose of the Study:

  • To identify risk factors for re-bleeding in patients with CDB.
  • To determine factors influencing the identification of the bleeding source during colonoscopy.
  • To establish appropriate initial management and colonoscopy indications for CDB patients.

Main Methods:

  • Retrospective analysis of 285 patients diagnosed with CDB who underwent colonoscopy between March 2004 and October 2015.
  • Statistical analysis to correlate re-bleeding with patient background and initial management.
  • Evaluation of examination conditions affecting bleeding point identification.

Main Results:

  • Re-bleeding occurred in 28% of patients.
  • A history of CDB (OR 2.1) and chronic kidney disease (CKD; OR 2.3) were identified as risk factors for re-bleeding.
  • Bleeding point identification, achieved in 70% of patients with CT-detected extravasation undergoing urgent colonoscopy, significantly reduced re-bleeding by approximately 80% (OR 0.20).

Conclusions:

  • Contrast-enhanced CT upon patient arrival is recommended for evaluating CDB.
  • Patients with CT-identified extravasation, a history of CDB, or CKD are strong candidates for urgent colonoscopy.
  • Successful identification of the bleeding source during colonoscopy is a critical factor in preventing recurrent bleeding.
Abstract

Keywords:
ColonColonic diverticular bleedingColonoscopyComputed tomographyEndoscopyLower gastrointestinal bleedingRe-bleedingRisk factors

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