Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage
Aim. This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods. This retrospective study included 142 participants who were urgently hospitalized...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2020/3283940 |
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| author | Hirosato Doi Keita Sasajima Masanori Takahashi Taira Sato Iichirou Ootsu Ryo Chinzei |
| author_facet | Hirosato Doi Keita Sasajima Masanori Takahashi Taira Sato Iichirou Ootsu Ryo Chinzei |
| author_sort | Hirosato Doi |
| collection | DOAJ |
| description | Aim. This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods. This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy. Results. Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,P=0.690) and recurrent bleeding (22.7% vs. 20.0%, P=0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68–12.0, P<0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23–7.53, P=0.016). Conclusions. In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage. |
| format | Article |
| id | doaj-art-4b86bcefb57d4e57a4d791a61550d1f7 |
| institution | DOAJ |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-4b86bcefb57d4e57a4d791a61550d1f72025-08-20T03:20:14ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972020-01-01202010.1155/2020/32839403283940Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular HemorrhageHirosato Doi0Keita Sasajima1Masanori Takahashi2Taira Sato3Iichirou Ootsu4Ryo Chinzei5Department of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanDepartment of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanDepartment of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanDepartment of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanDepartment of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanDepartment of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, JapanAim. This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods. This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy. Results. Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,P=0.690) and recurrent bleeding (22.7% vs. 20.0%, P=0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68–12.0, P<0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23–7.53, P=0.016). Conclusions. In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage.http://dx.doi.org/10.1155/2020/3283940 |
| spellingShingle | Hirosato Doi Keita Sasajima Masanori Takahashi Taira Sato Iichirou Ootsu Ryo Chinzei Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage Canadian Journal of Gastroenterology and Hepatology |
| title | Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage |
| title_full | Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage |
| title_fullStr | Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage |
| title_full_unstemmed | Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage |
| title_short | Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage |
| title_sort | effectiveness of conservative treatment without early colonoscopy in patients with colonic diverticular hemorrhage |
| url | http://dx.doi.org/10.1155/2020/3283940 |
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