Multicenter propensity score‐matched analysis comparing short versus long cap‐assisted colonoscopy for acute hematochezia

Abstract

Background and Aim While short and long attachment caps are available for colonoscopy, it is unclear which type is more appropriate for stigmata of recent hemorrhage (SRH) identification in acute hematochezia. This study aimed to compare the performance of short versus long caps in acute hematochezia diagnoses and outcomes. Methods We selected 6460 patients who underwent colonoscopy with attachment caps from 10 342 acute hematochezia cases in the CODE BLUE‐J study. We performed propensity score matching (PSM) to balance baseline characteristics between short and long cap users. Then, the proportion of definitive or presumptive bleeding etiologies found on the initial colonoscopy and SRH identification rates were compared. We also evaluated rates of blood transfusions, interventional radiology, or surgery, as well as the rate of rebleeding and mortality within 30 days after the initial colonoscopy. Results A total of 3098 patients with acute hematochezia (1549 short cap and 1549 long cap users) were selected for PSM. The rate of colonic diverticular bleeding (CDB) diagnosis was significantly higher in long cap users (P = 0.006). While the two groups had similar rates of the other bleeding etiologies, the frequency of unknown etiologies was significantly lower in long cap users (P < 0.001). The rate of SRH with active bleeding was significantly higher in long cap users (P < 0.001). Other clinical outcomes did not differ significantly. Conclusion Compared to that with short caps, long cap‐assisted colonoscopy is superior for the diagnosis of acute hematochezia, especially CDB, and the identification of active bleeding.

Direct clipping using a half‐opened reopenable clip and long hood for colonic diverticular bleeding

“…In hemoclipping, direct clipping of vessels at the base of the diverticula results in a lower rebleeding rate than does the suture method for the diverticula opening 3 . Moreover, the diagnostic rate of colonic diverticular bleeding is significantly higher among long‐cap users than among short‐cap users 4 . Use of a long hood enables aspiration with inversion and internal observation of the diverticulum.…”

“…3 Moreover, the diagnostic rate of colonic diverticular bleeding is significantly higher among long-cap users than among short-cap users. 4 Use of a long hood enables aspiration with inversion and internal observation of the diverticulum. An 80-year-old woman presented at our hospital with excessive bloody stools.…”