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Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score-matched analysis using a

Rintaro Moroi1, Kunio Tarasawa2, Hisashi Shiga1

  • 1Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

Journal of Gastroenterology and Hepatology
|October 29, 2020
PubMed

Insights

Urgent colonoscopy for colonic diverticular bleeding (CDB) significantly reduces in-hospital death and improves endoscopic hemostasis rates compared to elective procedures. This intervention is crucial for managing severe CDB cases effectively.

Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Endoscopy

Background:

  • Colonic diverticular bleeding (CDB) can be severe despite a generally good prognosis with conservative therapy.
  • The effectiveness of urgent colonoscopy and factors influencing CDB prognosis remain incompletely understood.

Purpose of the Study:

  • To evaluate the efficacy of urgent colonoscopy in managing CDB.
  • To identify clinical risk factors associated with unfavorable outcomes, including in-hospital mortality.

Main Methods:

  • Utilized the Diagnosis Procedure Combination database for patient data.
  • Employed propensity score matching to compare urgent versus elective colonoscopy groups.
  • Analyzed endoscopic hemostasis rates, in-hospital death rates, and length of hospital stay.
  • Conducted logistic regression to identify clinical factors impacting CDB events.

Main Results:

  • Urgent colonoscopy demonstrated a lower in-hospital death rate (0.35% vs. 0.58%) and higher endoscopic hemostasis rate (3.0% vs. 1.7%) compared to elective colonoscopy.
  • Hospitalization was shorter with urgent colonoscopy (8 vs. 9 days).
  • Multivariate analysis confirmed urgent colonoscopy's benefit in reducing in-hospital death (OR=0.67) and increasing endoscopic hemostasis (OR=1.84).

Conclusions:

  • Urgent colonoscopy appears effective in identifying bleeding sites and reducing mortality in CDB patients.
  • The timing and necessity of urgent colonoscopy should be individualized based on patient condition and clinical presentation.
Abstract

Keywords:
Diverticular bleedingPrognosisUrgent colonoscopy

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