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Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of
Masanori Ochi1, Toshiro Kamoshida2, Yukako Hamano2
1Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan. maochi-tei@umin.ac.jp.
Insights
Urgent computed tomography (CT) within 4 hours of bleeding, followed by colonoscopy, significantly reduces rebleeding rates in patients with colonic diverticular bleeding (CDB). Early colonoscopy alone did not improve outcomes.
Area of Science:
- Gastroenterology
- Radiology
- Colorectal Surgery
Background:
- Early colonoscopy within 24 hours is recommended for colonic diverticular bleeding (CDB).
- Limited data exists on 30-day rebleeding rates after colonoscopy for CDB.
- This study investigated the impact of timing of contrast-enhanced computed tomography (CT) on rebleeding rates.
Purpose of the Study:
- To evaluate the outcomes of early colonoscopy for CDB.
- To compare rebleeding rates based on the timing of CT imaging prior to colonoscopy.
Main Methods:
- Retrospective review of 182 patients with CDB undergoing CT and colonoscopy within 24 hours.
- Patients categorized into urgent CT (within 4 hours of last hematochezia) and elective CT (after 4 hours) groups.
- Primary outcomes: 30-day rebleeding rates and identification of stigmata of recent hemorrhage (SRH).
Main Results:
- Urgent CT identified SRH more frequently (35.0% vs. 7.3%, P < 0.01).
- Among patients with extravasation-positive CT, SRH detection was higher in the urgent CT group (66.0% vs. 20.0%, P < 0.01).
- Urgent CT and extravasation-positive findings correlated with significantly improved 30-day rebleeding rates (P < 0.05).
Conclusions:
- Colonoscopy within 24 hours is recommended for CDB patients with extravasation-positive CT findings within 4 hours of bleeding.
- Elective colonoscopy may be suitable for patients without urgent CT findings.
- Urgent CT aids in identifying active bleeding and reducing rebleeding risk.
Background:
Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended. However, little is known about rates of rebleeding within 30 d. We posited that a group of patients who underwent contrast-enhanced computed tomography (CT) within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.
Aim:
To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.
Methods:
Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed. Patients were divided into groups based on the timing of the CT imaging, within or at 4 h were defined as urgent CTs (n = 100) and those performed after 4 h were defined as elective CTs (n = 82). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH) (i.e., active bleeding, non-bleeding visible vessels, or adherent clots).
Results:
In total, 182 patients (126 men and 56 women) with median ages of 68.6 (range, 37-92) and 73.7 (range, 48-93) years, respectively, underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group (n = 100) and patients for whom CT was performed after 4 h were included in the elective CT group (n = 82). SRH were identified in 35.0% (35/100) of the urgent CT cases and 7.3% (6/82) of the elective CT cases (P < 0.01). Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0.01). Furthermore, rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases (P < 0.05). Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates. Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.
Conclusion:
To improve rates of rebleeding, colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hema-tochezia. Otherwise, elective colonoscopy can be performed.
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