Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding
Open Access
- 16 April 2021
- journal article
- research article
- Published by Baishideng Publishing Group Inc. in World Journal of Clinical Cases
- Vol. 9 (11), 2446-2457
- https://doi.org/10.12998/wjcc.v9.i11.2446
Abstract
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. To evaluate the outcomes of early colonoscopy for CDB among different groups of patients. 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). 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. 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.Keywords
This publication has 20 references indexed in Scilit:
- ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal BleedingThe American Journal of Gastroenterology, 2016
- Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasisGastrointestinal Endoscopy, 2015
- Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopyThe Esophagus, 2015
- The role of endoscopy in the patient with lower GI bleedingGastrointestinal Endoscopy, 2014
- Randomized Trial of Urgent vs. Elective Colonoscopy in Patients Hospitalized With Lower GI BleedingThe American Journal of Gastroenterology, 2010
- Urgent Colonoscopy for Evaluation and Management of Acute Lower Gastrointestinal Hemorrhage: A Randomized Controlled TrialThe American Journal of Gastroenterology, 2005
- Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleedingThe American Journal of Gastroenterology, 2003
- Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular HemorrhageThe New England Journal of Medicine, 2000
- Bleeding Colonic Diverticula A Reappraisal of Natural History and ManagementAnnals of Surgery, 1994
- Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media.Radiology, 1990