Risk factors of interventional radiology/surgery for colonic diverticular bleeding
Yoshinori Sato1, Hiroshi Yasuda1, Yusuke Nakamoto1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.
Insights
Interventional radiology or surgery effectively treats severe colonic diverticular bleeding (CDB) when endoscopy fails. However, this approach does not prevent late recurrent bleeding episodes after initial treatment.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Colorectal Surgery
Background:
- Colonic diverticular bleeding (CDB) is a common cause of lower gastrointestinal bleeding.
- While often self-limiting, severe CDB may necessitate urgent intervention.
- Identifying risk factors for intervention and recurrence is crucial for patient management.
Purpose of the Study:
- To identify risk factors associated with the need for interventional radiology (IR) or surgery in patients with CDB.
- To evaluate the rates of early and late recurrent bleeding after IR/surgery for CDB.
Main Methods:
- Retrospective case-control study including 608 patients hospitalized for CDB.
- Logistic regression analysis was used to identify risk factors for requiring IR/surgery.
- Recurrent bleeding rates (early and late) were compared between patients who underwent IR/surgery and those who did not.
Main Results:
- 23 patients (3.8%) required IR/surgery.
- Independent risk factors for IR/surgery included shock (BP ≤90 mmHg), positive extravasation on CT, ≥2 early recurrent bleeding episodes, and right colon bleeding source.
- Early recurrent bleeding was significantly lower in the IR/surgery group (0% vs. 28.0%).
- Late recurrent bleeding rates were 43.4% in the IR/surgery group and 30.7% in the no IR/surgery group.
Conclusions:
- IR/surgery is an effective hemostatic option for refractory CDB.
- Despite successful initial hemostasis, late recurrent bleeding remains a significant concern and cannot be prevented by IR/surgery.
Background And Aim:
Colonic diverticular bleeding (CDB) stops spontaneously, but sometimes, excessive bleeding does not allow hemostasis and requires interventional radiology (IR)/surgery. We examined risk factors in patients who required IR/surgery for CDB and late recurrent bleeding rate after IR/surgery.
Methods:
This retrospective case-control study was conducted at a tertiary center. We included 608 patients who required hospitalization for CDB. Patients were investigated for risk factors using logistic regression analysis. We also investigated early and late recurrent bleeding rates following IR/surgery.
Results:
In 261 patients (42.9%), the bleeding source was identified, and endoscopic hemostasis was performed; 23 (3.8%) required IR/surgery. In multivariate analysis, shock state with a blood pressure of ≤90 mmHg (P < 0.001; odds ratio [OR], 20.1; 95% confidence interval [CI], 5.08-79.5), positive extravasation on contrast-enhanced computed tomography (P < 0.001; OR 9.5, 95% CI 2.85-31.4), two or more early recurrent bleeding episodes (P = 0.002; OR 7.4, 95% CI 2.14-25.4), and right colon as the source of bleeding (P = 0.023; OR 4.1, 95% CI 1.25-14.0) were independent risk factors requiring IR/surgery. Early recurrent bleeding was observed in 0% and 28.0% patients (P < 0.001) in the IR/surgery and no IR/surgery groups, respectively, whereas late recurrent bleeding rate was observed in 43.4% and 30.7% patients (P = 0.203) in the IR/surgery and no IR/surgery groups, respectively. Four patients who required surgery experienced late recurrent bleeding at a site different from the initial CDB.
Conclusions:
Although IR/surgery is an effective hemostatic treatment wherein endoscopic treatment is unsuccessful, late recurrent bleeding cannot be prevented.
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