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Urgent colonoscopy is not necessary in case of colonic diverticular bleeding without extravasation on
Tomoya Sugiyama1, Yuki Kojima2, Yoshikazu Hirata2
1Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
Insights
Urgent colonoscopy (UCS) is not necessary for patients with colonic diverticular bleeding (CDB) without extravasation on CT scans. This study found no significant difference in rebleeding rates or clinical outcomes between patients who underwent UCS and those who received conservative management.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Radiology
Background:
- Acute lower gastrointestinal bleeding (ALGIB) is common, particularly in older adults and those on antiplatelet therapy.
- Colonic diverticular bleeding (CDB) is the leading cause of ALGIB, often managed with endoscopic hemostasis.
- The utility of urgent colonoscopy (UCS) in CDB patients without extravasation on contrast-enhanced computed tomography (CECT) remains debated regarding clinical outcomes.
Purpose of the Study:
- To evaluate the efficacy of urgent colonoscopy (UCS) in managing colonic diverticular bleeding (CDB) patients without evidence of extravasation on CECT.
- To determine if UCS improves clinical outcomes, including rebleeding rates and hospitalization duration, in this specific patient group.
Main Methods:
- A retrospective study of 282 patients with CDB without extravasation on CECT treated between July 2014 and July 2019.
- Comparison of clinical outcomes between 74 patients who underwent UCS and 208 patients managed conservatively (non-UCS).
- Analysis of very early rebleeding (within 5 days) and early rebleeding (6-30 days), blood transfusion requirements, and hospitalization duration.
Main Results:
- No significant difference was observed in very early rebleeding rates between the UCS and non-UCS groups.
- Clinical course factors, including rebleeding rates, blood transfusion needs, and hospitalization duration, did not differ significantly between the UCS and non-UCS groups.
- Urgent colonoscopy did not improve the rebleeding rate or overall clinical course for CDB patients without extravasation on CECT.
Conclusions:
- Urgent colonoscopy is not a necessary intervention for colonic diverticular bleeding patients when CECT shows no extravasation.
- Conservative management appears to be a viable strategy for CDB patients without extravasation on CECT, avoiding potential risks and costs of unnecessary procedures.
- Further research may refine management strategies for ALGIB based on imaging findings and patient-specific factors.
Background And Aims:
Acute lower gastrointestinal bleeding (ALGIB) increase with age and the administration of antiplatelet drugs. Colonic diverticular bleeding (CDB) is the most common cause of ALGIB, and endoscopic hemostasis is an effective treatment for massive CDB. But in patients without extravasation on contrast-enhanced computed tomography (CECT), the efficacy of urgent colonoscopy (UCS) is controversial from the point of the clinical course, including rebleeding rate. We aimed to establish a potential strategy including UCS for CDB patients without extravasation on CECT.
Patients And Methods:
Patients from two centers treated for CDB without extravasation on CECT between July 2014 and July 2019 were retrospectively identified (n = 282). Seventy-four underwent UCS, and 208 received conservative management. We conducted two analyses. The first analysis investigates the risk factors of rebleeding rate within 5 days after administration (very early rebleeding), and no UCS (NUCS) was not the independent factor of the very early rebleeding. The second analysis is whether UCS positively influenced the clinical course after hospitalization.
Results:
The prevalence of very early rebleeding and early rebleeding (6-30 days from admission), patients requiring blood transfusion within 0-5 days and 6-30 days post-admission, and duration of hospitalization were examined as clinical course factors between UCS and NUCS group. There was no significant difference between the UCS and non-UCS groups in the clinical course factors. UCS for the CDB patients without extravasation was not improved rebleeding rate and clinical course.
Conclusions:
UCS is not necessary in case ofCDB patient without extravasation on CECT.
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