Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5555-5559
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5555
Effectiveness of therapeutic barium enema for diverticular hemorrhage
Mizue Matsuura, Masahiko Inamori, Atsushi Nakajima, Yasuhiko Komiya, Yumi Inoh, Keigo Kawasima, Mai Naitoh, Yuji Fujita, Akiko Eduka, Noriyoshi Kanazawa, Shiori Uchiyama, Rie Tani, Kennichi Kawana, Setsuya Ohtani, Hajime Nagase
Mizue Matsuura, Masahiko Inamori, Atsushi Nakajima, Hepatology and Gastroenterology, Yokohama City University Hospital, Yokohama 236-0004, Japan
Yasuhiko Komiya, Yumi Inoh, Keigo Kawasima, Mai Naitoh, Yuji Fujita, Akiko Eduka, Noriyoshi Kanazawa, Shiori Uchiyama, Rie Tani, Kennichi Kawana, Setsuya Ohtani, Hajime Nagase, Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama 236-0004, Japan
Author contributions: Nakajima A, Kawasima K, Ohtani S and Nagase H had full access to the data and were involved in the study design and concept, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content; Komiya Y, Inoh Y, Kawana K, Naitoh M and Fujita Y were involved in the study concept and design and drafting of the manuscript; Eduka A, Kanazawa N, Uchiyama S and Tani R drafted the manuscript and critically revised the manuscript for important intellectual content; all authors provided final approval to submit the manuscript for publication.
Supported by Research funding, Abbott Japan Co., LTD.
Ethics approval: The study was reviewed and approved by the Yokohama City University Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: Masahiko Inamori has received research funding from Abbott Japan Co., LTD.
Data sharing: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masahiko Inamori, MD, PhD, Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. inamorim@med.yokohama-cu.ac.jp
Telephone: +81-45-7872640 Fax: +81-45-7843546
Received: October 22, 2014
Peer-review started: October 28, 2014
First decision: November 14, 2014
Revised: December 3, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: May 14, 2015
Processing time: 208 Days and 1 Hours
Abstract

AIM: To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.

METHODS: We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August 2010 and March 2012 at Yokohama Rosai Hospital. Twenty patients were included in the review, consisting of 14 men and 6 women. The median age of the patients was 73.5 years. The duration of the follow-up period ranged from 1 to 19 mo (median: 9.8 mo). Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization, 6 patients who required it for re-bleeding that developed after the patient left the hospital, and 3 patients who required the procedure for the prevention of re-bleeding. Barium (concentration: 150 w%/v%) was administered per the rectum, and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy. After confirmation that the ascending colon and cecum were filled with barium, the enema tube was withdrawn, and the patient’s position was changed every 20 min for 3 h.

RESULTS: Twelve patients remained free of re-bleeding during the follow-up period (range: 1-19 mo) after the therapeutic barium enema, including 9 men and 3 women with a median age of 72.0 years. Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years: 4 developed early re-bleeding, defined as re-bleeding that occurs within one week after the procedure, and the remaining 4 developed late re-bleeding. The DFI (disease-free interval) decreased 0.4 for 12 mo. Only one patient developed a complication from therapeutic barium enema (colonic perforation).

CONCLUSION: Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.

Keywords: Non-steroidal antiinflammatory drugs; Barium enema; Diverticular hemorrhage; Re-bleeding; Barium impaction

Core tip: In patients who present with diverticular bleeding, while endoscopic hemostasis is an effective treatment, the source of the bleeding is often difficult to identify because of massive bleeding and the presence of clots. We use therapeutic barium enema as a second-line treatment in cases where the source of bleeding cannot be identified by endoscopy. Therapeutic barium enema can be used relatively safely and has a low degree of invasiveness. When no other therapeutic techniques are available, therapeutic barium enema may be useful as a therapeutic alternative that can preclude the need for surgical treatment.