Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study.

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.