The ins and outs of diverticular bleeding

Jensen, Dennis M.

doi:10.1016/j.gie.2011.09.004

Cited by 18 publications

(27 citation statements)

References 8 publications

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“…In a prospective study of patients with severe hematochezia, among those with a definitive diagnosis of diverticula hemorrhage, the source of bleeding was more likely to be diverticula in the proximal colon compared with the distal colon. 13 And in a recent analysis using data from the Nationwide Inpatient Sample, hospitalizations for diverticular bleeding were significantly more common in Blacks compared with Whites. 14 The greater burden of proximal diverticula in Blacks compared with Whites may contribute to this significant difference.…”

Section: Discussionmentioning

confidence: 99%

Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

Peery

Keku

Martin

et al. 2016

Clinical Gastroenterology and Hepatology

139

113

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Background & Aims Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for symptomatic and costly diverticular disease. We aimed to assess the number, location, and characteristics of colonic diverticula in a large US screening population. Methods We analyzed data from a prospective study of 624 patients (mean age, 54 years) undergoing screening colonoscopy at the University of North Carolina Hospital from 2013 through 2015. The examination included a detailed assessment of colonic diverticula. To assess the association between participant characteristics and diverticula, we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Of our population, 260 patients (42%) had one or more diverticula (mean number 14; range, 1–158). Participants with diverticula were more likely to be older, male, and have a higher body mass index than those without diverticula. The distribution of diverticula differed significantly by race. Among Whites, 75% of diverticula were in the sigmoid colon, 11% in the descending splenic flexure, 6% in the transverse colon, and 8% were in the ascending colon or hepatic flexure; in Blacks 64% of diverticula were in the sigmoid colon, 8% in the descending colon or splenic flexure, 7% in the transverse colon, and 20% in the ascending colon or hepatic flexure (P=.0008). The proportion of patients with diverticula increased with age: 35% were 50 years or younger, 40% were 51–60 years, and 58% were older than 60 years. The proportion of patients with more than 10 diverticula increased with age: 8% were 50 years or younger, 15% were 51–60 years, and 30% were older than 60 years. Conclusions Older individuals not only have a higher prevalence of diverticula than younger individuals, but also a greater density, indicating that this is a progressive disease. Blacks have a greater percentage of their diverticula in the proximal colon and fewer in the distal colon compared with Whites. Understanding the distribution and determinants of diverticula is the first step in preventing diverticulosis and its complications.

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Section: Discussionmentioning

confidence: 99%

Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

Peery

Keku

Martin

et al. 2016

Clinical Gastroenterology and Hepatology

139

113

View full text Add to dashboard Cite

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“…This represents a clinically significant reduction in the rebleeding rate and forms the basis for recommending a major change in the definitive diagnosis and treatment of diverticular hemorrhage. This moves away from the previous practice of angiography or colonic surgical resection to urgent colonoscopy [16]. It is also reported to be more cost effective [10, 11, 13••].…”

Section: Diagnostic and Therapeutic Modalitiesmentioning

confidence: 99%

“…These studies report similar or lower rebleeding rates than with hemoclip placement and their benefit may be most pronounced in the right colon [17, 18]. However, this technique requires two colonoscopies and is not deemed to be as convenient or effective, particularly in Western patients, compared to hemostasis with thermal probes or hemoclips [16]. …”

Section: Diagnostic and Therapeutic Modalitiesmentioning

confidence: 99%

Lower GI Bleeding: Epidemiology and Management

Ghassemi¹,

Jensen²

2013

Curr Gastroenterol Rep

Self Cite

141

100

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Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent diagnosis and intervention to achieve definitive hemostasis. Colonoscopy is the primary modality for establishing a diagnosis, risk stratification, and treating some of the most common causes of colonic bleeding, including diverticular hemorrhage which is the etiology in 30 % of cases. Other interventions, including angiography and surgery, are usually reserved for instances of bleeding that cannot be stabilized or allow for adequate bowel preparation for colonoscopy. We discuss the colonoscopic diagnosis, risk stratification, and definitive treatment of colonic hemorrhage in patients presenting with severe hematochezia.

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“…After receiving standard supportive medical care including fluid resuscitation and hemodynamic monitoring, endoscopy was performed for the diagnosis and treatment of the bleeding lesions in the small bowel, including a duodenal vascular ectasia (one case), jejunal bleeding diverticulum (one case), ileal Dieulafoy's lesion (one case) and ileal bleeding diverticula (three cases). A bleeding diverticulum was defined as a diverticulum with stigmata of recent hemorrhage such as active bleeding, a non-bleeding visible vessel, or an adherent clot [26,27] . Informed written consent was obtained from all patients for endoscopy and EBL.…”

Section: Patient Populationmentioning

confidence: 99%

Endoscopic band ligation for bleeding lesions in the small bowel

Ikeya¹

2014

WJGE

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AIM:To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel.METHODS: This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. RESULTS:Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. CONCLUSION:EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Endoscopic band ligation; Small bowel; Diverticular hemorrhage; Jejunal bleeding; Ileal bleeding; Therapeutic endoscopy; Hemostasis Core tip: There have been few reports regarding the use of endoscopic band ligation (EBL) for the treatment of bleeding lesions in the small intestine. The present study demonstrates safe and effective use of EBL to treat six patients with small bowel lesions including, duodenal vascular ectasia, ileal Dieulafoy's lesion, and jejunal and ileal bleeding diverticula. Although the bleeding was successfully managed in all patients, those with diverticular bleeding in the small bowel should be closely monitored after an initial EBL.

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The ins and outs of diverticular bleeding

Cited by 18 publications

References 8 publications

Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

Lower GI Bleeding: Epidemiology and Management

Endoscopic band ligation for bleeding lesions in the small bowel

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