Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular Hemorrhage

Jensen, Dennis M.; Machicado, Gustavo A.; Jutabha, Rome; Kovacs, Thomas O.

doi:10.1056/nejm200001133420202

Cited by 629 publications

(624 citation statements)

References 13 publications

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“…2 After initial hemodynamic resuscitation, emergent endoscopy is the initial treatment of choice for both acute UGIB 3 and LGIB. [4][5][6] However, the ideal management for ongoing bleeding after failure of endoscopic therapy remains controversial. Acute surgical intervention will eventually be required in 10%-15% of patients, 7 but is associated with a mortality of 25%.…”

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confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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Background: Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. Methods:We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ 2 , Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses.Results: Eighteen of 83 (22%) patients had active extravasation on initial angiog raphy and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). Conclusion:The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

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confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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“…[32]. Every type of endoscopic hemostasis (epinephrine injection and/or bipolar electrocoagulation) was able to prevent early rebleeding [32]. It is also reported that urgent colonoscopy, after adequate colon cleansing and performed by an experienced endoscopist, is able to decrease direct costs and shorten hospital stay in these patients [33,34].…”

Section: Colonoscopy and Diverticular Bleedingmentioning

confidence: 99%

“…For example, Setoyama et al found that endoscopic band ligation was superior to endoscopic clipping in reducing rebleeding rate (p=0.018) [30]. [32]. Every type of endoscopic hemostasis (epinephrine injection and/or bipolar electrocoagulation) was able to prevent early rebleeding [32].…”

Section: Colonoscopy and Diverticular Bleedingmentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

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Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

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“…Early colonoscopy reduces hospital stay and costs (Strate 2003, Machicado 1997. Therapeutic colonoscopy also reduces the need for surgery (Jensen 2000).…”

Section: Colonoscopymentioning

confidence: 99%

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

2017

International Journal of Research Studies in Medical and Health

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ABSTRACT:Acute lower Gastro intestinal bleeding is a relatively common problem in the emergency department. Etiology is diverse as is the degree of bleeding and natural history. Hence there are a number of subtle aspects of clinical assessment, investigations and management which require attention and application fr optimal outcomes. The goal of this review is to highlight the practical issues in managing the condition from the perspective of a medical officer or a junior resident in surgery who is on-call in the emergency department. A working algorithm incorporating the key management issues is also presented.

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Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular Hemorrhage

Abstract: Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatment of such patients with epinephrine injections, bipolar coagulation, or both may prevent recurrent bleeding and decrease the need for surgery.

Cited by 629 publications

References 13 publications

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

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