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Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study
Shotaro Umezawa1, Naoyoshi Nagata1, Jun Arimoto1
1From the Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanagawa-ku, Yokohama 236-0004 Japan (S. Umezawa, S. Uchiyama, T.H., A.N.); Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan (N.N., T.S., S.M.); Department of Gastroenterology, Hiratsuka Citizen Hospital, Kanagawa, Japan (J.A.); Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan (K.N., N.I.); Department of Endoscopy, Koritsu Showa Hospital, Tokyo, Japan (Y.T.); Department of Gastroenterology, Yokohama Rosai Hospital, Kanagawa, Japan (H.N.); Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan (H.K.); and Department of Gastroenterology, Keiyu Hospital, Kanagawa, Japan (A.M.).
Insights
Precolonoscopy contrast-enhanced CT is useful for diagnosing colonic diverticular bleeding (CDB). While sensitivity is moderate, high specificity aids in identifying bleeding diverticula, especially when CT is performed within 4 hours of hematochezia.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Colonic diverticular bleeding (CDB) is a common cause of lower gastrointestinal bleeding.
- Accurate and timely diagnosis is crucial for effective management.
- Precolonoscopy imaging can aid in identifying the source of bleeding.
Purpose of the Study:
- To evaluate the utility of intravenous contrast material-enhanced computed tomography (CT) performed before colonoscopy for diagnosing colonic diverticular bleeding (CDB).
- To determine the accuracy of CT in predicting stigmata of recent hemorrhage during colonoscopy.
Main Methods:
- A prospective, multicenter, observational study included 442 patients with acute hematochezia.
- Computed tomography (CT) with intravenous contrast was performed before colonoscopy.
- Statistical analyses included Mann-Whitney U test, chi-squared test, and multivariable logistic regression.
Main Results:
- Of 442 patients, 202 were diagnosed with CDB.
- CT showed positive extravasation in 24.7% of patients.
- CT extravasation findings had a sensitivity of 57.6% and specificity of 91.2% for predicting stigmata of recent hemorrhage.
- Sensitivity was higher when CT was performed within 4 hours of the last hematochezia (64.7% vs 33.3%).
Conclusions:
- Intravenous contrast-enhanced CT demonstrates high specificity for predicting stigmata of recent hemorrhage in colonic diverticular bleeding.
- CT sensitivity is improved when performed within 4 hours of the last hematochezia.
- Urgent precolonoscopy CT can assist in decisions regarding the need for immediate colonoscopy.
Abstract:
Purpose To demonstrate the usefulness of precolonoscopy intravenous contrast material-enhanced CT for colonic diverticular bleeding (CDB). Materials and Methods A prospective, multicenter, observational study was performed. Patients with acute-onset hematochezia who were admitted to hospital were included, and those without CDB were excluded. CT was performed before colonoscopy. A Mann-Whitney U test, χ2 test, and multivariable logistic regression analysis were performed to determine the accuracy of CT before colonoscopy. Results A total of 442 patients (mean age, 71.2 years; 302 male patients; 68.3% men) were included between January 2014 and December 2015, and 202 patients were diagnosed as having CDB. The positive extravasation rate during CT was 50 of 202 (24.7%) among all patients and five of nine (55.6%) among patients who underwent CT within 1 hour of the last hematochezia. At multivariable analysis, the interval from the last hematochezia until CT was a predictor of extravasation (beta coefficient, -.0038 ± 0.0014 [standard deviation]). Extravasation at CT had a sensitivity of 38 of 66 (57.6%; 95% confidence interval: 44.8%, 69.7%) and a specificity of 124 of 136 (91.2%; 95% confidence interval: 85.1%, 95.4%) for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy. The sensitivity was higher in patients who underwent CT examination within 4 hours of hematochezia, compared with those examined after 4 hours (64.7% [33 of 51] vs 33.3% [five of 15]; P < .01). Conclusion Extravasation findings for CT with intravenous contrast material had high specificity for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy, regardless of the timing of the CT examination. Although the sensitivity was relatively low, it was higher when the CT examination was performed within 4 hours after the last hematochezia. Therefore, urgent precolonoscopy CT may contribute to decision making regarding whether an urgent colonoscopy should be performed.
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