Risk factors of interventional radiology/surgery for colonic diverticular bleeding

Sato, Yoshinori; Yasuda, Hiroshi; Nakamoto, Yusuke; Kiyokawa, Hirofumi; Yamashita, M.; Matsuo, Yasumasa; Maehata, Tadateru; Yamamoto, Hiroyuki; Mimura, Hidefumi; Itoh, Fumio

doi:10.1002/jgh3.12499

Cited by 5 publications

(10 citation statements)

References 32 publications

(83 reference statements)

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“…In addition, a history of hypertension and diabetes, which are not ER risk factors, were found to be risk factors for LR. These findings indicate that ER and LR are independent events, which is consistent with previous studies in which ER occurs at the same diverticulum whereas LR occurs at a different diverticulum [13,14]. Previous studies focused on risk factors for rebleeding, such as age over 70 years, a history of hypertension and hyperlipidemia, use of antiplatelet, and creatinine level greater than 1.5 mg/dl [2,3,[5][6][7].…”

Section: Discussionsupporting

confidence: 89%

“…Definitive CDH was defined as CDH with SRH by endoscopy, whereas presumptive CDH was defined as acute hematochezia with diverticula but no other major colonic lesions or evidence of SRH. ER was defined as fresh bloody stool within 30 days of hospitalization, dark red stool that required another emergency colonoscopy, or a decrease in hemoglobin level to 2 g/dL or lower as previously described [14]. LR was defined as rebleeding and rehospitalization for patients with CDH between 31 days and 12 months after the initial admission, as previously described [14].…”

Section: Methodsmentioning

confidence: 99%

“…ER was defined as fresh bloody stool within 30 days of hospitalization, dark red stool that required another emergency colonoscopy, or a decrease in hemoglobin level to 2 g/dL or lower as previously described [14]. LR was defined as rebleeding and rehospitalization for patients with CDH between 31 days and 12 months after the initial admission, as previously described [14].…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

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Development of risk scores for early and late recurrence of colonic diverticular hemorrhage

Watanabe

Miyakawa

Sato

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Objectives Colonic diverticular hemorrhage (CDH) often recurs. Although several studies have suggested that early rebleeding (ER) and late rebleeding (LR) should be treated independently, and several ER/LR risk factors have been identified, an integrated system for risk evaluation is still lacking. This study aimed to develop risk scores for early and late rebleeding of CDH. Methods This two-center, retrospective cohort study included 218 patients between 2008 and 2021. ER and LR risk factors were identified using multivariate analysis, and risk scores were developed using the odds ratios of each risk factor. Results: The ER and LR rates were 32.6 and 25.7%, respectively. High heart rate on admission, early endoscopy from the visit, no bowel preparation and no endoscopic treatment were identified as risk factors for ER. On the other hand, LR risk factors included a history of hypertension and diabetes, early endoscopy from the visit, and the use of endoscopic clips. The ER risk score [area under the curve (AUC) = 0.71] was highly sensitive (90.3%) at a cutoff point of 6 and highly specific (98.0%) at a cutoff point of 15. The LR risk score (AUC = 0.70) was highly sensitive (91.1%) at a cutoff point of 2.6 and highly specific (88.3%) at a cutoff point of 7.1. Conclusions The ER and LR risk scores were established for the first time, and they can divide CDH patients based on their risk of rebleeding as well as provide clinicians with practical information about the CDH management.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Study Design Setting and Participantsmentioning

confidence: 99%

See 1 more Smart Citation

Development of risk scores for early and late recurrence of colonic diverticular hemorrhage

Watanabe

Miyakawa

Sato

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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“…( 26 ) When considering the treatment strategy for diverticular haemorrhage, if endoscopic hemostasis with clips fails, it can be used as a landmark to select a vessel for TAE. ( 27 ) However, without bowel preparation before colonoscopy, bleeding and endoscopic hemostasis are difficult to observe. It is also important to note the possibility of aspiration of the intestinal cleansing agent in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Successful endoscopic hemostasis compared to transarterial embolization in patients with colonic diverticular bleeding

Mori

Sekiguchi

Mishima

et al. 2022

J. Clin. Biochem. Nutr.

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Transarterial embolization (TAE) is performed in patients with colonic diverticular bleeding after difficult endoscopic hemostasis or rebleeding. A total of 375 patients with hematochezia at our hospital from 1 April 2016 to 31 March 2020 were retrospectively analysed. Firstly, we compared the group in which hemostasis was achieved by endoscopy alone with the group that eventually underwent TAE. Secondly, we compared the group in which hemostasis was achieved by endoscopy alone, with the group switched to TAE after endoscopic hemostasis failed. The group that eventually underwent TAE had a higher shock index and lower Alb and PT% than the endoscopic hemostasis group. The shock index was correlated with Alb and PT%. When the cut-off value for the shock index was defined as more than 0.740, an OR of 9.500, a positive predictive value (PPV) of 40.0%, a negative predictive value (NPV) of 93.4%, and an accuracy of 80.3% were obtained for predicting a switch to TAE treatment. The greatest risk for TAE was the presence of shock and extravasation on contrast-enhanced CT. A switch to TAE treatment was likely when the shock index was more than 0.740. TAE should be considered in cases with a high shock index and showing extravasation on contrast-enhanced CT.

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“…The recurrence of bleeding may also be affected by whether the bleeding vessel is venous or arterial. Because diverticular bleeding in the right colon is often severe (38)(39)(40)(41), arterial bleeding may occur more commonly in the right colon than in the left colon. Consequently, the right colon may also be prone to recurrent bleeding.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Clipping for Definitive Colonic Diverticular Bleeding in Preventing Early Recurrent Bleeding

et al. 2022

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Objective Clipping is a common technique for managing colonic diverticular bleeding (CDB), despite the lack of published evidence regarding its effectiveness. We aimed to evaluate the effectiveness of clipping for CDB in preventing early recurrent bleeding. Methods This dual-center retrospective study included 93 patients who underwent emergency hospitalization for bloody stool, diagnosed with definitive CDB, and treated with clipping or conservative treatment. The primary outcome was early recurrent bleeding. A logistic regression analysis was performed to assess the association between the occurrence of early recurrent bleeding and clipping with adjustment for propensity scores. Secondary outcomes included death, transfusion, length of hospitalization, need for transcatheter arterial embolization or surgery, and adverse events. ResultsThe patient characteristics were similar between the clipping (n=85) and conservative treatment (n= 8) groups. The rate of early recurrent bleeding was significantly lower in the clipping group than in the conservative treatment group [23.5% (20 cases) vs. 75% (6 cases), p=0.005]. In the propensity score-adjusted logistic regression analysis, the odds ratio for early recurrent bleeding in the clipping group was 0.094 (95% confidence interval, 0.008-0.633, p=0.026). Secondary outcomes were not significantly different between the two groups. Stigmata of recent hemorrhage (SRH) at the time of recurrent bleeding was identified in 79.2% of patients (19/24). In the clipping group, recurrent bleeding was observed in 62.5% of cases (10/16) from the same diverticulum. However, early recurrent bleeding tended to be less likely with direct clipping (p= 0.072). Conclusion Clipping for definite CDB was more effective in preventing early recurrent bleeding than conservative treatment.

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Risk factors of interventional radiology/surgery for colonic diverticular bleeding

Cited by 5 publications

References 32 publications

Development of risk scores for early and late recurrence of colonic diverticular hemorrhage

Development of risk scores for early and late recurrence of colonic diverticular hemorrhage

Successful endoscopic hemostasis compared to transarterial embolization in patients with colonic diverticular bleeding

Effectiveness of Clipping for Definitive Colonic Diverticular Bleeding in Preventing Early Recurrent Bleeding

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