Embolization as First-Line Therapy for Diverticulosis-Related Massive Lower Gastrointestinal Bleeding: Evidence From a Meta-analysis

Khanna, Amit; Ognibene, Steven J.; Koniaris, Leonidas G.

doi:10.1016/j.gassur.2004.09.039

Cited by 99 publications

(52 citation statements)

References 35 publications

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“…According to the previous reports, colonoscopic clipping may be the most effective and safest treatment (11,13,23). Selective angiography techniques using smaller catheters to embolize the bleeding artery have shown high segmental ischemia in up to 20% of patients (24). In addition, there are a fewer number of radiologists, compared with endoscopists, who can accurately treat colonic diverticular bleeding using the TAE technique.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

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Objective Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding, and its incidence has recently increased. However, the treatment strategy of diverticular bleeding has not yet been established. The aim of the study was to investigate the efficacy of contrast-enhanced computed tomography (CECT) to determine the indication for urgent colonoscopy to achieve hemostasis. Methods A total of 124 patients diagnosed with diverticular bleeding between 2012 and 2013 in our hospital were analyzed. The clinical behavior, factors related to detecting bleeding diverticula, and risk factors for early rebleeding of diverticular bleeding were evaluated. Results Clinical behavior: Bleeding diverticula were identified in 23 of 124 (19%) patients and most of them (16/23; 70%) were located in the ascending colon. Hemostasis was achieved in all 23 cases, however, six (26%) developed early rebleeding. Factors for detecting bleeding diverticula: In patients in whom extravasation was detected using CECT, the endoscopic detection rate of bleeding diverticula was 60% (12/20), while bleeding diverticula were detected in only 31% (11/35) of patients in whom extravasation was not detected using CECT (p<0.05). The interval between the first hematochezia and colonoscopy in which the bleeding point was detected by colonoscopy (median 23.5 hours) was shorter than that in which bleeding diverticula were not detected (median 43.6 hours) (p<0.01). Risk factors for short term rebleeding: Using a univariate analysis, atherosclerotic comorbidity, anti-inflammatory drugs including low-dose aspirin, antithrombotic agents, vital signs on admission, hemoglobin level on hospitalization, and extravasation on CECT were not found to be significant risk factors. Conclusion The finding of extravasation on CECT is the most important factor for identifying and treating bleeding diverticula by colonoscopy. In such cases, urgent colonoscopy is recommended.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

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“…15,16 Management has also evolved with the advent of interventional endoscopy (bipolar coagulation, epinephrine injection, clip placement) 11,15,17,18 and angiographic treatment (intra-arterial infusion of vasopressin, transarterial embolization). [19][20][21][22] In the 10 patients treated on this last series and whose massive diverticular bleeding did not stop spontaneously, we could foresee haemostasis endoscopically in two and superselective embolization in four. Diverticular bleeding is caused by the rupture of small arteries, explaining the frequency of sudden haemorrhage associated with low blood pressure at admission, as observed in more than 25% of patients in this series.…”

Section: Patient Demographicsmentioning

confidence: 90%

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Poncet

Héluwaert

Voirin

et al. 2010

Aliment Pharmacol Ther

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“…a Tagged A recent meta-analysis of embolization as first line therapy for LGIB shows that diverticular bleeding may be particularly well suited to endovascular intervention [54]. Comparing diverticular and non-diverticular sources of LGIB, embolization achieves control of diverticular bleeding in 85% at 30 days.…”

Section: Catheter-directed Interventionmentioning

confidence: 99%

Interventional management of lower gastrointestinal bleeding

et al. 2008

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Lower gastrointestinal bleeding (LGIB) arises from a number of sources and is a significant cause of hospitalization and mortality in elderly patients. Whereas most episodes of acute LGIB resolve spontaneously with conservative management, an important subset of patients requires further diagnostic workup and therapeutic intervention. Endovascular techniques such as microcatheter embolization are now recognized as safe, effective methods for controlling LGIB that is refractory to endoscopic intervention. In addition, multidetector CT has shown the ability to identify areas of active bleeding in a non-invasive fashion, enabling more focused intervention. Given the relative strengths and weaknesses of various diagnostic and treatment modalities, a close working relationship between interventional radiologists, gastroenterologists and diagnostic radiologists is necessary for the optimal management of LGIB patients.

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Embolization as First-Line Therapy for Diverticulosis-Related Massive Lower Gastrointestinal Bleeding: Evidence From a Meta-analysis

Cited by 99 publications

References 35 publications

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Interventional management of lower gastrointestinal bleeding

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