Efficacy of transcatheter arterial embolization for first-line treatment of colonic diverticular bleeding with extravasation on contrast-enhanced computed tomography

Abstract

Colonic diverticular bleeding (CDB) is the most frequent cause of acute lower gastrointestinal bleeding. The aim of this study was to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for CDB as first-line treatment with extravasation on contrast-enhanced computed tomography (CECT), compared with endoscopic hemostasis. Three Japanese institutions participated in this retrospective cohort study. Data from consecutive patients admitted with a diagnosis of CDB with extravasation on CECT were reviewed. One hospital performed TAE and the others conducted urgent colonoscopy (CS) as the first-line treatment for CDB with extravasation on CECT. The primary outcome was rebleeding rate within 30 days after first-line treatment. In total, 165 CDB cases with extravasation on CECT (TAE group, n = 39; CS group, n = 126) were analyzed in this study. The rebleeding rate within 30 days was significantly lower in the TAE group (7.69%) than in the CS group (23.02%; P = .038). The bleeding point detection rate was significantly higher in the TAE group (89.74%, 35/39) than in the CS group (37.30%, 47/126; P < .0001). Even in those cases in which a bleeding point was detected, the rebleeding rate was significantly lower in the TAE group (0%) than in the endoscopic hemostasissuccess group (23.91%; P = .005). No severe complications of Grade 3 or more were seen with TAE. We showed that TAE is an effective, safe hemostatic method, and a useful alternative to endoscopic hemostasis for first-line treatment of CDB.

Transcatheter Arterial Embolisation of NSAID- Induced Diverticular Haemorrhage: A Case Report

“…Despite the above, recent trials have been investigating if utilising contrast-enhanced CT angiography and TAE should be a first-line measure. For example, a retrospective cohort study by Kojima et al showed significantly reduced 30-day rebleeding rates for patients receiving first-line treatment with TAE (7.69%) instead of colonoscopy (23.02%; p = 0.038) [13]. Additionally, they were able to demonstrate that bleeding point detection was less likely via colonoscopy (37.30%) than using angiography (89.74%; p < 0.001) [13].…”

“…For example, a retrospective cohort study by Kojima et al showed significantly reduced 30-day rebleeding rates for patients receiving first-line treatment with TAE (7.69%) instead of colonoscopy (23.02%; p = 0.038) [13]. Additionally, they were able to demonstrate that bleeding point detection was less likely via colonoscopy (37.30%) than using angiography (89.74%; p < 0.001) [13]. Other studies report immediate cessation of bleeding in over 80% of cases [14][15][16][17].…”