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

Abstract

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.

Gastrointestinal bleeding among 151 patients undergoing maintenance hemodialysis for end-stage renal failure: A 5-year follow-up study

“…[30] In the present study, over 50% of the patients with upper GI bleeding who underwent hemodialysis were prescribed proton pump inhibitors or H2-receptor blockers as a prophylactic measure. The reason why the complication rate of upper GI bleeding in hemodialysis patients in the present study was high compared to the previous study [7,21,[28][29][30] is unknown, and warrants further prospective studies with an increased number of patients. Notably, patients with upper GI bleeding often have several comorbidities, such as ischemic heart disease, cerebrovascular disease, and infectious diseases.…”

“…Although the complication rate of GI bleeding was relatively high during hemodialysis, successful endoscopic hemostasis was achieved in all patients in the present study. Although several previous studies have suggested that performing hemostasis in hemodialysis patients is challenging, [6,7,9,13,19,21] the present study found that hemodialysis had no detrimental effects on endoscopic hemostasis.…”

“…Although the primary causes of upper GI bleeding in Japan were previously peptic ulcers caused by Helicobacter pylori (H pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs), [7,16] there has been a recent rise in cases of GI bleeding caused by NSAIDs and antithrombotics in both the upper and lower GI tract. [7,14,[16][17][18][19][20][21][22] Although several studies [8][9][10][11][12] and a recent meta-analysis [23] indicate that the incidence of GI bleeding increases in renal failure and that the increase in GI bleeding is exacerbated by hemodialysis, few recent studies have demonstrated the realworld clinical characteristics of hemodialysis patients in a time dependent-manner. The present study aimed to examine the characteristics of upper and lower GI bleeding in 151 chronic hemodialysis patients at Takagi Hospital, a regional core hospital in Japan, over a 5-year longitudinal observational period.…”

“…Although the primary causes of upper GI bleeding in Japan were previously peptic ulcers caused by Helicobacter pylori (H pylori ) infection and nonsteroidal anti-inflammatory drugs (NSAIDs), [7,16] there has been a recent rise in cases of GI bleeding caused by NSAIDs and antithrombotics in both the upper and lower GI tract. [7,14,16–22]…”

Risk factors for difficult endoscopic hemostasis for colonic diverticular bleeding and efficacy and safety of transcatheter arterial embolization

“…Ueda et al reported a higher shock index and extravasation on contrast-enhanced CT in patients who underwent TAE than in those who underwent endoscopic hemostasis; however, the outcomes and complications were not compared between the 2 groups. [42] Superselective arterial embolization has a high hemostasis rate (97%) and low intestinal ischemia and rebleeding rates (7% and 15%, respectively). [24] On the other hand, TAE has evaluated the efficacy and safety of TAE.…”