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

Sugiyama, Tomoya; Hirata, Yoshikazu; Kojima, Yuki; Kanno, Takeshi; Kimura, Mikitoshi; Okuda, Yusuke; Haneda, Kenichi; Ikeuchi, Hirokazu; Morikawa, Tomohiro; Mochizuki, Hisato; Tanaka, Hiroki; Sobue, Satoshi

doi:10.2169/internalmedicine.54.5097

Cited by 34 publications

(44 citation statements)

References 25 publications

(36 reference statements)

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“…Conversely, bleeding diverticula were identified on colonoscopy in 60-68% of patients with extravasation on CE-CT (positive predictive value) and 20-31% of those without extravasation, demonstrating a higher identification rate in the former [67,69]. In one of the retrospective observational studies, CE-CT significantly improved the rate of identifying vascular lesions (35.7 vs. 20.6%; p = 0.01) and the rate of providing endoscopic therapy (34.9 vs. 13.4%; p < 0.01), with a high rate of agreement regarding the source of bleeding between CE-CT and colonoscopy (κ value: 0.83; p < 0.01) [68].…”

Section: Cq9: Is Contrast Enhanced (Ce)-ct Prior To Colonoscopy Effecmentioning

confidence: 95%

“…Quality of evidence: C Strength of recommendation: Probably do it Agreement rate: 75% Explanation Three retrospective observational studies [67][68][69] and one prospective observational study [70] have investigated whether pre-colonoscopy CE-CT improves the rate of identifying the source of bleeding and the diverticula with SRH in patients presenting with acute LGIB or colonic diverticular bleeding, showing a low rate of positive extravasation (15-36%) and a low sensitivity (20-52%) on CE-CT [67][68][69][70]. Conversely, bleeding diverticula were identified on colonoscopy in 60-68% of patients with extravasation on CE-CT (positive predictive value) and 20-31% of those without extravasation, demonstrating a higher identification rate in the former [67,69].…”

Section: Cq9: Is Contrast Enhanced (Ce)-ct Prior To Colonoscopy Effecmentioning

confidence: 99%

“…Quality of evidence: C Explanation Colonic diverticular bleeding generally occurs at the base or neck of diverticula due to damage to the vasa recta [84], and endoscopic hemostasis is provided by epinephrine injection [35,62,85,86], coagulation [35,62,85,87], clipping [35,58,62,67,80,85,86,[88][89][90][91][92][93], and ligation (EBL and detachable snare ligation) [83,88,91,[94][95][96][97]. The over-the-scope clip system was also used to achieve endoscopic hemostasis in a recent study [98].…”

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

“…Because of its rare association with tissue damage, endoscopic clipping is used commonly for hemostasis in patients with colonic diverticular bleeding [58,67,80,[88][89][90][91][92][93]. Clipping is largely classified into a direct method, in which vasa recta are clipped directly, and an indirect method, in which the openings of the diverticula are closed.…”

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

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Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Section: Cq9: Is Contrast Enhanced (Ce)-ct Prior To Colonoscopy Effecmentioning

confidence: 95%

Section: Cq9: Is Contrast Enhanced (Ce)-ct Prior To Colonoscopy Effecmentioning

confidence: 99%

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

confidence: 99%

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Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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“…In the present review, 10 reports were selected [26][27][28][29][30][31][32][33][34][35] to avoid overlapping cases among papers published from the same hospitals (Table 2). Primary hemostasis was achieved in 83-100% of cases, with an average of 97% in 383 cases treated by endoscopic clipping.…”

Section: Endoscopic Clippingmentioning

confidence: 99%

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

Kaise

Nagata²,

Ishii

et al. 2019

Digestive Endoscopy

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There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrastenhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion. Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 241 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 247 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 249

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Usefulness of a long hood for the detection of bleeding sites in colonic diverticular hemorrhage: A randomized controlled trial

Shiomi,

Nagata,

Tsuzuki

et al. 2024

JGH Open

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Background and AimThe use of a hood at the tip of a colonoscope enables aspiration, inversion of the diverticulum, and observation of the inside of the diverticulum. In most previous studies, a short hood was used; however, observation of the diverticulum is often inadequate. Long food is promising by previous research, but it was a retrospective study using propensity matching and has some limitations. We compared the identification rate of stigmata of recent hemorrhage (SRH) between the long and standard hoods in cases of suspected colonic diverticular hemorrhage (CDH) to confirm the usefulness of long hood by prospective randomized controlled trial.MethodsEighty patients (42 in the long hood group [L group] and 38 in the short hood group [S group]) who visited the Saitama Medical University Hospital and Tokai University Hachioji Hospital between December 2018 and July 2021 with a chief complaint of bloody stool and suspected CDH, based on the clinical course and imaging studies, were included. Patients were randomly assigned to the L or S group.ResultsRegarding patient background, age was significantly higher in the L group; however, no significant differences were found in medical history or history of antithrombotic medication or nonsteroidal anti‐inflammatory drug use. Identification rate of SRH was significantly higher in the L group (58.5%, 24/42 patients) than in the S group (26.3%, 10/38 patients) (P < 0.05). All patients were treated using the clip method, and the rate of rebleeding within 1 month was not significantly different between the two groups.ConclusionA long hood was more useful compared with a short hood in identifying SRH of CDH (UMIN000034603).

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

Cited by 34 publications

References 25 publications

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

Usefulness of a long hood for the detection of bleeding sites in colonic diverticular hemorrhage: A randomized controlled trial

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