Massive and recurrent diverticular hemorrhage, risk factors and treatment

Gilshtein, Hayim; Kluger, Yoram; Khoury, Areen; Issa, Nidal; Khoury, Wisam

doi:10.1016/j.ijsu.2016.07.076

Cited by 18 publications

(21 citation statements)

References 13 publications

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“…In this study, there was no difference in the rate of early rebleeding between the definite and presumptive CDB groups. Previous studies have revealed that CDB of the right colon was a significant risk factor for rebleeding requiring surgical resection . The predilection towards right‐sided CDB in the presumptive group fight affect the rate of early rebleeding.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Honda

Ishii

Takasu

et al. 2019

J of Gastro and Hepatol

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Background and Aim The risk factors for early rebleeding following the management of colonic diverticular bleeding (CDB) are unclear. This study aimed to determine the risk factors for early rebleeding following initial colonoscopy. Methods Overall, 370 patients with CDB were divided as having presumptive (229) or definite CDB with stigmata of recent hemorrhage (141) on the basis of initial colonoscopy. Definite CDB cases were treated by either endoscopic clipping (EC) or endoscopic band ligation (EBL) as a first‐line treatment. Time‐to‐event analysis for early rebleeding was performed by Kaplan–Meier methods with log‐rank test between the three groups (presumptive, EC, and EBL). Multivariate Cox proportional hazards regression was used to identify risk factors for early rebleeding. Results There were 38 and 103 patients in the EC and EBL groups, respectively. Early rebleeding developed in 61 cases (16.5%). The cumulative incidence rates of early rebleeding at 1, 5, and 30 days were 7.7%, 16.4%, and 17.9% in the presumptive group; 1.9%, 7.0%, and 9.5% in the EBL group; and 2.6%, 34.9%, and 37.7% in the EC group, respectively (log‐rank test, P = 0.00059). Moreover, 90.2% of early rebleeding occurred within 5 days. Adjusted hazard ratio (HR) was marginally lower in the presumptive group (HR = 0.50; 95% confidence interval, 0.26–1.01; P = 0.052) and significantly lower in the EBL‐treated group than in the EC group (HR = 0.21; 95% confidence interval, 0.09–0.50; P = 0.0004). Conclusions Most early rebleeding occurred within 5 days after initial colonoscopy. EC was less effective than EBL in terms of early rebleeding.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have revealed that CDB of the right colon was a significant risk factor for rebleeding requiring surgical resection. 34,35 The predilection towards right-sided CDB in the presumptive group fight affect the rate of early rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Honda

Ishii

Takasu

et al. 2019

J of Gastro and Hepatol

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“…Rebleeding from diverticula after successful endoscopic hemostasis is also a critical problem and the incidence was reported to be between 10.8 % and 43.4 % 6 7 . Risk factors for colonic diverticular rebleeding have been identified: bleeding from the right colon, shock, hypertension, hyperlipidemia, and the use of NSAIDs or anti-thrombotic drugs 7 8 9 10 . However, endoscopic visibility of diverticula with bleeding has not been evaluated in association with rebleeding risk, although variety is observed in the appearance of diverticular bleeding, including active spurting from diverticula and vessel exposure in the diverticular bed.…”

Section: Introductionmentioning

confidence: 99%

Risk of colonic diverticular rebleeding according to endoscopic appearance

et al. 2018

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Background and study aims Re-commencement of bleeding (rebleeding) of colonic diverticula after endoscopic hemostasis is a clinical problem. This study aimed to examine whether endoscopic visibility of colonic diverticular bleeding affects the risk of rebleeding after endoscopic hemostasis. Patients and methods We performed a retrospective review of endoscopic images and medical charts of patients with colonic diverticular bleeding who underwent endoscopic hemostasis. Endoscopic visibility was classified into two types according to visibility of the source of bleeding; source invisibility due to bleeding or attached hematin (type 1), or endoscopically visible responsive vessels (type 2). Rebleeding rates within one year after initial hemostasis were examined. Results Of 93 patients with successful endoscopic hemostasis, 38 (41 %) showed type 1 visibility, while the remaining presented type 2. All patients received hemostasis with clipping, rebleeding developed in 20 patients (22 %). Type 1 visibility was more likely to be observed in patients with rebleeding (65 % vs. 34 %, P = 0.013). Multivariate analysis revealed that after endoscopic hemostasis, type 1 visibility (invisible source) was the only independent risk factor for colonic diverticular rebleeding (odds ratio, 3.05; 95 % confidence interval, 1.03 – 9.59, P = 0.044). Kaplan-Meier curve showed the cumulative incidence of rebleeding was significantly higher in patients with type 1 visibility than those with type 2 visibility ( P = 0.0033, log-rank test) Conclusion Hemostasis by clipping for colonic diverticular bleeding without definite observation of the source of bleeding may not be sufficiently effective. Other hemostatic methods, including band ligation, should be considered when the source of bleeding is unclear.

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“…18 Surgical intervention may be needed for patients with uncontrollable bleeding. 19,20 Therefore, endoscopic hemostasis is recommended for a colonic diverticulum with SRH; leading from this, improvement of SRH detection rate is the key for CDB management. 1,15,18 The use of a water-jet scope was introduced by Ishii et al as a safe and effective endoscopic treatment for CDB in 2010.…”

Section: Introductionmentioning

confidence: 99%

Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding

2021

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Background/Aims: In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB. Methods: This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke's International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records. Results: A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events. Conclusions: The gel immersion method was found to be effective, especially for massive right-sided CDB. Clin Endosc 2020 Aug 11.

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Massive and recurrent diverticular hemorrhage, risk factors and treatment

Abstract: Right colon diverticulosis rather than patient characteristics and medical treatment should prompt for aggressive management with lower threshold for surgical intervention.

Cited by 18 publications

References 13 publications

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Risk of colonic diverticular rebleeding according to endoscopic appearance

Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding

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