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Zeng S, Zhang Q, Li Q, Luo Q, Jiang M, Cheng CS. Surgical suture-assisted endoscopic band ligation for the management of recurrent hemostasis after unsuccessful use of hemoclips for diverticular bleeding. Endoscopy 2023; 55:E1164-E1165. [PMID: 37984392 PMCID: PMC10659840 DOI: 10.1055/a-2183-6154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Shaoxiong Zeng
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qu Zhang
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qin Li
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qingtian Luo
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Minwen Jiang
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Chun-sheng Cheng
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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Sebastian SA, Co EL, Panthangi V, Bansal R, Narayanan V, Paudel S, Raja R, Padda I, Mohan BP. Colonic diverticular bleeding: An update on pathogenesis and management. Dis Mon 2023; 69:101543. [PMID: 36918300 DOI: 10.1016/j.disamonth.2023.101543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.
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Affiliation(s)
| | - Edzel Lorraine Co
- University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | | | - Radha Bansal
- Government Medical College & Hospital, Chandigarh, India
| | | | | | - Rabab Raja
- All Saints University School of Medicine, Dominica
| | - Inderbir Padda
- Richmond University Medical Center, Staten Island, New York, USA
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah School of Medicine, Utah, USA
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Guo X, Patel B, Han L, Van Alstine WG, Noblet JN, Chambers SD, Kassab GS. Novel patch biomaterial treatment for colon diverticulosis in swine model. Front Bioeng Biotechnol 2023; 11:1215362. [PMID: 37588135 PMCID: PMC10425590 DOI: 10.3389/fbioe.2023.1215362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Current leading managements for diverticular disease cannot prevent the recurrence of diverticulitis, bleeding and/or other complications. There is an immediate need for developing new minimal invasive therapeutic strategies to prevent and treat this disease. Through a biomechanical analysis of porcine colon with diverticular lesions, we proposed a novel adhesive patch concept aiming at mechanical reconstruction of the diseased colon wall. This study aims to evaluate the surgical feasibility (safety and efficacy) of pulmonary visceral pleura (PVP) patch therapy using a pig model of diverticulosis. Six female Yucatan miniature pigs underwent collagenase injection (CI) for the development of diverticular lesions. The lesions in each animal either received patch implantation (treated group, n = 40 for 6 pigs) or left intact (untreated group, n = 44 for 6 pigs). The normal colonic wall in each animal received patch implantation at two spots to serve as control (n = 12 for 6 pigs). After 3 months of observation, the performance and safety of the patch treatment were evaluated through macroscopic and histological examination. We found that 95% of pouch-like herniation of the mucosa was prevented from the colon wall with the treatment. The pouch diameter was significantly reduced in the treated group as compared to the untreated group (p < 0.001). The patch application caused a significant increase in the levels of collagen of the colon tissue as compared to the untreated and control groups (p < 0.001). No difference was found in the lymphocyte and macrophage inflammatory infiltrate between the groups. Our results suggest that patch treatment efficiently inhibits the diverticular pouch deformation and promotes the healing of the colon wall with a normal inflammatory response, which may minimize the risk of diverticulosis reoccurrence and complications over time.
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Affiliation(s)
- Xiaomei Guo
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | - Bhavesh Patel
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | - Ling Han
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | | | | | | | - Ghassan S. Kassab
- California Medical Innovations Institute Inc, San Diego, CA, United States
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Uehara N, Inoue K, Kuroki Y, Miyao N, Iwahashi K, Suzuki R, Endo T, Asonuma K, Yoshida E, Koshibu N, Tabuchi A, Tohata M, Hanamura S, Gomi K, Yamamoto Y, Nagahama M. Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding. DEN OPEN 2023; 3:e184. [PMID: 36426137 PMCID: PMC9680167 DOI: 10.1002/deo2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment. METHODS This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis. RESULTS The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing.In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80-14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09-0.88, p = 0.035). CONCLUSIONS In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis-related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.
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Affiliation(s)
- Natsumi Uehara
- Department of GastroenterologyMedical Topia Soka HospitalSaitamaJapan
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Kazuaki Inoue
- Department of GastroenterologyInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Yuichiro Kuroki
- Department of GastroenterologySt. Marianna University School of MedicineYokohama City Seibu HospitalKanagawaJapan
| | - Naoki Miyao
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | | | - Reika Suzuki
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Toshiyuki Endo
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Kunio Asonuma
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Erika Yoshida
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Naoko Koshibu
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Akihiro Tabuchi
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Misako Tohata
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Shotaro Hanamura
- Department of GastroenterologyKikuna Memorial HospitalKanagawaJapan
| | - Kuniyo Gomi
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Yorimasa Yamamoto
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Masatsugu Nagahama
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
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Werner DJ, Wenzel N, Abusalim N, Kiesslich R, Baar T, Tresch A, Rey JW. Unmasking lower gastrointestinal bleeding under administration of norepinephrine. World J Radiol 2022; 14:375-383. [PMID: 36605886 PMCID: PMC9808013 DOI: 10.4329/wjr.v14.i12.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding. Contrast extravasation is a prerequisite for successful embolization. Provocative angiography is helpful in the detection of elusive bleeding.
AIM We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies, as well as the role of norepinephrine (NE) in unmasking bleeding.
METHODS We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 years. All patients had a positive shock index and needed intensive care.
RESULTS In three of four patients, angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic stabilization.
CONCLUSION We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful embolization. However, this statement must be confirmed in prospective studies.
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Affiliation(s)
- David John Werner
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
- Radiologie Rhein-Nahe, Krankenhaus St. Marienwörth, Bad Kreuznach 55543, Rheinland-Pfalz, Germany
| | - Nicolai Wenzel
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
| | - Nael Abusalim
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center Hanau, Hanau 63450, Hessen, Germany
| | - Ralf Kiesslich
- Department of Internal Medicine II, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
| | - Till Baar
- Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne 50923, Nordrhein-Westfalen, Germany
| | - Achim Tresch
- Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne 50923, Nordrhein-Westfalen, Germany
| | - Johannes Wilhelm Rey
- Department of Internal Medicine II, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden 65199, Hessen, Germany
- Department of Gastroenterology and Endoscopy, Medical Center Osnabrueck, Osnabrueck 49076, Niedersachsen, Germany
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Efficacy of Combination Therapy with Epinephrine Local Injection and Hemostatic Clips on Active Diverticular Bleeding. J Clin Med 2022; 11:jcm11175195. [PMID: 36079125 PMCID: PMC9457277 DOI: 10.3390/jcm11175195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Epinephrine local injection is a hemostatic procedure used in active diverticular bleeding that elicits vasoconstriction and tamponade effects. We compared the additional benefit of combination therapy with HSE-C (hypertonic saline epinephrine injection with clipping) to clipping monotherapy. Retrospective data on diverticular bleeding between 2011 and 2016 was reviewed. Those with an active bleeding source confirmed by colonoscopy (excluding non-bleeding vessels and adherent clots) who received either HSE-C or clipping were evaluated. Endpoints were rates of successful primary hemostasis, recurrent bleeding, and surgical intervention during hospitalization. A total of 320 patients with diverticular bleeding were evaluated, on which either HSE-C (n = 35) or clipping monotherapy (n = 18) was performed. Rates of successful primary hemostasis (91.4% vs. 66.7%, p = 0.048) and direct placement of endoclips (60.0% vs. 16.7%, p = 0.004) were significantly higher in the HSE-C group. Although not statistically significant, the HSE-C group had a higher rate of early rebleeding (18.8% vs. 8.3%, p = 0.653), while no difference was seen in the number of patients requiring surgery (11.4% vs. 5.5%, p = 0.651). HSE-C is associated with a higher rate of successful primary hemostasis for severe active diverticular bleeding but has no significant difference in reducing early recurrent bleeding or the number of patients requiring surgery, suggesting that hemostatic effects may be temporary.
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7
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Kubo Y, Kobayashi S, Yamamoto K, Nakagawa Y, Yamashita K, Saito T, Tanaka K, Makino T, Yamamoto K, Takahashi T, Kurokawa Y, Yamasaki M, Eguchi H, Doki Y, Nakajima K. Endoscopic application of novel, infection‐free, advanced hemostatic material: Its usefulness to upper gastrointestinal oozing. DEN OPEN 2022; 2:e25. [PMID: 35310741 PMCID: PMC8828191 DOI: 10.1002/deo2.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Yuto Kubo
- Department of Next Generation Endoscopic Intervention (Project ENGINE) Graduate School of Medicine Center of Medical Innovation and Translational Research Osaka University Osaka Japan
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | | | | | | | - Kotaro Yamashita
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE) Graduate School of Medicine Center of Medical Innovation and Translational Research Osaka University Osaka Japan
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
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Sato Y, Nakatsu-Inaba S, Matsuo Y, Yamashita M, Ikeda H, Yasuda H, Itoh F. Efficient Colonoscopic Identification of Colonic Bleeding Diverticulum Using Intradiverticular Water Injection with a Nontraumatic Tube. J Anus Rectum Colon 2021; 5:313-318. [PMID: 34395945 PMCID: PMC8321589 DOI: 10.23922/jarc.2021-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The colonoscopic identification of stigmata of recent hemorrhage (SRH) in patients with colonic diverticular bleeding (CDB) is difficult. Factors that influence the identification of SRH in the diagnosis of CDB were investigated. Methods: This was a retrospective study of 487 early colonoscopy patients with acute lower gastrointestinal bleeding who were diagnosed with CDB. Comorbidities, medications, bowel preparation, use of a transparent cap, use of a water-jet scope, colonoscopy by an expert colonoscopist, and use of a nontraumatic (NT) tube were assessed. A multivariate analysis was used to estimate the odds ratio and 95% confidence interval. Results: Of the 487 colonoscopy patients diagnosed with CDB, 191 (39%) were definitively identified with SRH. The use of a transparent cap, a water-jet scope, an expert colonoscopist, and an NT tube were independent predictive factors for SRH on univariate analysis. A multivariable logistic regression model showed that colonoscopy by an expert colonoscopist and the use of an NT tube were predictive factors for SRH. Conclusions: Intradiverticular water injection with an NT tube by an expert colonoscopist is useful in identifying CDB, and may help achieve effective endoscopic hemostasis.
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Affiliation(s)
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Satoko Nakatsu-Inaba
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Yasumasa Matsuo
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Masaki Yamashita
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Hiroki Ikeda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine
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Werner DJ, Baar T, Kiesslich R, Wenzel N, Abusalim N, Tresch A, Rey JW. Endoscopic hemostasis makes the difference: Angiographic treatment in patients with lower gastrointestinal bleeding. World J Gastrointest Endosc 2021; 13:221-232. [PMID: 34326943 PMCID: PMC8311471 DOI: 10.4253/wjge.v13.i7.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment. However, a small number of these may pose a challenge in terms of therapy because the patients develop hemodynamic instability, and endoscopy does not achieve adequate hemostasis. Interventional radiology supplemented with catheter angiography (CA) and transarterial embolization have gained importance in recent times. AIM To evaluate clinical predictors for angiography in patients with lower gastrointestinal bleeding (LGIB). METHODS We compared two groups of patients in a retrospective analysis. One group had been treated for more than 10 years with CA for LGIB (n = 41). The control group had undergone non-endoscopic or endoscopic treatment for two years and been registered in a bleeding registry (n = 92). The differences between the two groups were analyzed using decision trees with the goal of defining clear rules for optimal treatment. RESULTS Patients in the CA group had a higher shock index, a higher Glasgow-Blatchford bleeding score (GBS), lower serum hemoglobin levels, and more rarely achieved hemostasis in primary endoscopy. These patients needed more transfusions, had longer hospital stays, and had to undergo subsequent surgery more frequently (P < 0.001). CONCLUSION Endoscopic hemostasis proved to be the crucial difference between the two patient groups. Primary endoscopic hemostasis, along with GBS and the number of transfusions, would permit a stratification of risks. After prospective confirmation of the present findings, the use of decision trees would permit the identification of patients at risk for subsequent diagnosis and treatment based on interventional radiology.
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Affiliation(s)
- David John Werner
- Radiologie Rhein-Nahe, Krankenhaus am St. Marienwörth, Bad Kreuznach 55543, RLP, Germany
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Germany, Wiesbaden 65199, Hessen, Germany
| | - Till Baar
- Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Germany, Cologne 50923, NRW, Germany
| | - Ralf Kiesslich
- Department of Internal Medicine II, Helios Dr. Horst-Schmidt-Clinic, Wiesbaden, Germany, Wiesbaden 65199, Hessen, Germany
| | - Nicolai Wenzel
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Germany, Wiesbaden 65199, Hessen, Germany
| | - Nael Abusalim
- Department of Radiology, Helios Dr. Horst-Schmidt-Clinic, Germany, Wiesbaden 65199, Hessen, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center Hanau, Germany, Hanau 63450, Hessen, Germany
| | - Achim Tresch
- Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Germany, Cologne 50923, NRW, Germany
- CECAD, University of Cologne, Germany, Cologne 50923, NRW, Germany
- Center for Data and Simulation Science, University of Cologne, Germany, Cologne 50923, NRW, Germany
| | - Johannes Wilhelm Rey
- Department of Gastroenterology and Endoscopy, Medical Center Osnabrueck, Germany, Osnabrueck 49076, Niedersachsen, Germany
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10
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Nagata N, Niikura R, Ishii N, Kaise M, Omata F, Tominaga N, Kitagawa T, Ikeya T, Kobayashi K, Furumoto Y, Narasaka T, Iwata E, Sugimoto M, Itoi T, Uemura N, Kawai T. Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1738-1743. [PMID: 33295071 DOI: 10.1111/jgh.15370] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short-term and long-term rebleeding between them. Thus, we conducted a systematic review and meta-analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB. METHODS A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated. RESULTS Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping. CONCLUSION Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short-term and long-term durations.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Mitsuru Kaise
- Gastroenterology Division, Nippon Medical School, Tokyo, Japan
| | - Fumio Omata
- Gastroenterology Division, St. Luke's International University, Tokyo, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan
| | - Tomoyuki Kitagawa
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takashi Ikeya
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
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11
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Yamauchi A, Kou T, Kishimoto T, Mori Y, Osawa K, Iimori K, Iwano K, Kawai Y, Sawada K, Hamada K, Nishimura S, Mori Y, Watanabe K, Azuma S, Morita T, Kurita A, Kawaguchi K, Suginoshita Y, Katayama T, Yazumi S. Risk factor analysis for early rebleeding after endoscopic treatment for colonic diverticular bleeding with stigmata of recent hemorrhage. JGH OPEN 2021; 5:573-579. [PMID: 34013057 PMCID: PMC8114991 DOI: 10.1002/jgh3.12535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 11/11/2022]
Abstract
Background and Aim Colonic diverticular bleeding is a common cause of acute lower gastrointestinal bleeding. Endoscopic hemostasis is generally selected as the first-line treatment; however, a considerable number of patients experience early rebleeding after endoscopic treatment. We investigated the risk factors for early rebleeding after endoscopic treatment. Methods We retrospectively evaluated the data of 142 consecutive patients who underwent endoscopic treatment (endoscopic clipping or endoscopic band ligation) for colonic diverticular bleeding with stigmata of recent hemorrhage between April 2012 and April 2020. Multivariate logistic regression analysis was conducted to evaluate the statistical relationship between patient characteristics and the incidence of early rebleeding occurring within 30 days after endoscopic treatment. Results Of 142 patients, early rebleeding was detected in 34 (23.9%) patients. According to univariate analysis, platelet count of <10 × 104/μL, bleeding from the left-sided colon, and endoscopic clipping usage were associated with early rebleeding (P < 0.05). The subsequent multivariate logistic regression analysis identified bleeding from the left-sided colon (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.73-10.0; P = 0.001) and endoscopic clipping usage (OR, 2.92; 95% CI, 1.21-7.00; P = 0.017) as the independent risk factors for early rebleeding. Conclusions Bleeding from the left-sided colon and endoscopic clipping usage were the risk factors for early rebleeding after endoscopic treatment. Using endoscopic band ligation was associated with a decreased risk for early rebleeding compared with the use of endoscopic clipping, indicating that endoscopic band ligation was a preferable endoscopic modality to prevent early recurrent bleeding.
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Affiliation(s)
- Atsushi Yamauchi
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Tadayuki Kou
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Takuya Kishimoto
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yuki Mori
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kazuki Osawa
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kei Iimori
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kosuke Iwano
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yuya Kawai
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kenji Sawada
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kensuke Hamada
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Satoshi Nishimura
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yoshiharu Mori
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kotaro Watanabe
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Shunjiro Azuma
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Toshihiro Morita
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Akira Kurita
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kiyotaka Kawaguchi
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yoshiki Suginoshita
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Toshiro Katayama
- Department of Medical Engineering, Faculty of Health Science Morinomiya University of Medical Sciences Osaka Japan
| | - Shujiro Yazumi
- Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
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12
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Goda Y, Kobara H, Kobayashi N, Nishiyama N, Fujihara S, Tada N, Kozuka K, Matsui T, Chiyo T, Shi T, Fujita K, Tani J, Yachida T, Takata M, Okano K, Nakano D, Nishiyama A, Mori H, Masaki T. Long-term outcomes of over-the-scope clip for refractory gastrointestinal diseases. MINIM INVASIV THER 2021; 31:628-634. [PMID: 33423604 DOI: 10.1080/13645706.2020.1867584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Over-The-Scope Clip (OTSC) can effectively treat refractory gastrointestinal diseases. However, most reports have focused on short-term effectiveness. We examined clinical outcomes of the deployed clips and long-term characteristics. MATERIAL AND METHODS Of 47 patients with OTSC treatment, 35 with follow-up periods of ≥3 months were retrospectively examined. The indications were 11 bleedings, 17 perforations, and seven fistulas. The observation period was defined as medium-term (3 to <12 months) or long-term (≥12 months). The primary outcome was the clinical success rate without disease recurrence. The secondary outcomes were the complication rate, survival duration, and clip retention rate. RESULTS The medium- and long-term clinical success rates were 100% during the observation period (median, 44 months; range, 3-78 months). The complication rate was 2.9% (n = 1). The median survival time was 1,634 days for bleeding, 1,757 days for perforation, and 444 days for fistulas. The overall clip retention rates were 56.4%, 38.1%, 30.9%, and 25.9% after one, six, and 12 months and at the final follow-up, respectively. The average clip retention duration was 244 days in bleeding, 656 days in perforations, and 188 days in fistulas. CONCLUSIONS Regardless of clip detachment, the OTSC can be effective in long-term.
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Affiliation(s)
- Yasuhiro Goda
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Hideki Kobara
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Nobuya Kobayashi
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Noriko Nishiyama
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Shintaro Fujihara
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Naoya Tada
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Kazuhiro Kozuka
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Takanori Matsui
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Taiga Chiyo
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Tingting Shi
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Koji Fujita
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Joji Tani
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Tatsuo Yachida
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Masashi Takata
- Department of Gastroenterology, Kochi Health Sciences Center, Kochi, Japan
| | - Keiichi Okano
- Gastroenterological Surgery, Kagawa University, Miki, Japan
| | - Daisuke Nakano
- Pharmacology, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Akira Nishiyama
- Pharmacology, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Hirohito Mori
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
| | - Tsutomu Masaki
- Departments of Gastroenterology and Neurology, Kagawa University, Miki, Japan
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13
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Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage. Can J Gastroenterol Hepatol 2020; 2020:3283940. [PMID: 32399458 PMCID: PMC7201635 DOI: 10.1155/2020/3283940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023] Open
Abstract
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.
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14
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Choe EK, Lee JE, Chung SJ, Yang SY, Kim YS, Shin ES, Choi SH, Bae JH. Genome-wide association study of right-sided colonic diverticulosis in a Korean population. Sci Rep 2019; 9:7360. [PMID: 31089239 PMCID: PMC6517584 DOI: 10.1038/s41598-019-43692-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/27/2019] [Indexed: 02/06/2023] Open
Abstract
Diverticulosis results from complex interactions related to aging, environmental factors and genetic predisposition. Despite epidemiologic evidence of genetic risk factors, there has been no attempt to identify genes that confer susceptibility to colonic diverticulosis. We performed the first genome-wide association study (GWAS) on susceptibility to diverticulosis in a Korean population. A GWAS was carried out in 7,948 healthy individuals: 893 patients and 1,075 controls comprised the test set, and 346 patients and 305 controls comprised the replication set. Diverticulosis was diagnosed by colonoscopy during comprehensive medical check-ups, and single-nucleotide polymorphisms (SNPs) related to diverticulosis were detected with the Affymetrix Axiom KORV1.1-96 Array. In all, 9 SNPs were identified in three SNP aggregates in the test set (P < 10−3, within 200 kb) after adjusting for sex. All the SNPs were replicated in the replication set (P < 0.05). Three SNPs were near the WNT4 gene, four near the RHOU gene, and two in the OAS1/3 genes. The top SNP associated with right-sided colonic diverticulosis was rs22538787, located near the WNT4 gene [combined set, P-value = 3.128 × 10−6, odds ratio = 1.415 (95% confidence interval: 1.223–1.637)]. These 9 novel SNP alleles associated with the WNT4, RHOU, and OAS1/3 genes are possibly involved in the underlying genetic susceptibility to right-sided diverticulosis. Our results provide basic knowledge about the development of diverticulosis in an Asian population.
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Affiliation(s)
- Eun Kyung Choe
- Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | | | - Su Jin Chung
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Sun Young Yang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Young Sun Kim
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | | | - Seung Ho Choi
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea.
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15
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Hookey L, Barkun A, Sultanian R, Bailey R. Successful hemostasis of active lower GI bleeding using a hemostatic powder as monotherapy, combination therapy, or rescue therapy. Gastrointest Endosc 2019; 89:865-871. [PMID: 30612959 DOI: 10.1016/j.gie.2018.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Acute lower GI bleeding is a frequent cause of hospital admission. The objective of this study was to evaluate the safety and performance of a hemostatic powder (TC-325/Hemospray) in the treatment of nonvariceal lower GI bleeding. METHODS Patients were enrolled into this prospective, multicenter, single-arm study at 4 tertiary care centers in Canada. Fifty patients with active lower GI bleeding of multiple different causes (52 bleeding sites) underwent topical endoscopic application of hemostatic powder. The primary endpoint was powder-related adverse events within 30 days of the index procedure. Secondary endpoints were initial hemostasis as well as recurrent bleeding and mortality within 30 days of the index procedure. RESULTS Most patients (96%) had a single bleeding site, and most bleeding (73%) was due to polypectomy. Overall, the powder was applied as monotherapy in 13 bleeding sites (25%), as combination therapy in 22 bleeding sites (42.3%), and as rescue therapy in 17 bleeding sites (32.7%). Hemostasis was achieved in 98% of patients. No patient experienced a powder-related adverse event. Five patients (10%) developed recurrent bleeding within 30 days. One patient (2%) died within 30 days of powder application, but the death was not directly related to hemostatic powder use. CONCLUSIONS The hemostatic powder is a safe and effective option for patients with lower GI bleeding of varying causes, and in particular, postpolypectomy hemorrhage. The hemostatic powder is effective as monotherapy, part of a combination approach, or as a rescue therapeutic option for the treatment of nonvariceal lower GI bleeding. (Clinical trial registration number: NCT02099435.).
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Affiliation(s)
| | - Alan Barkun
- Department of Medicine, Division of Gastroenterology, McGill University, Montreal, Quebec, Canada
| | - Richard Sultanian
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Robert Bailey
- Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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16
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Raña-Garibay R, Salgado-Nesme N, Carmona-Sánchez R, Remes-Troche J, Aguilera-Carrera J, Alonso-Sánchez L, Arnaud-Carreño C, Charúa-Guindic L, Coss-Adame E, de la Torre-Bravo A, Espinosa-Medina D, Esquivel-Ayanegui F, Roesch-Dietlen F, López-Colombo A, Muñoz-Torres J, Noble-Lugo A, Rojas-Mendoza F, Suazo-Barahona J, Stoopen-Rometti M, Torres-Flores E, Vallejo-Soto M, Vergara-Fernández O. The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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17
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Raña-Garibay R, Salgado-Nesme N, Carmona-Sánchez R, Remes-Troche JM, Aguilera-Carrera J, Alonso-Sánchez L, Arnaud-Carreño C, Charúa-Guindic L, Coss-Adame E, de la Torre-Bravo A, Espinosa-Medina D, Esquivel-Ayanegui F, Roesch-Dietlen F, López-Colombo A, Muñoz-Torres JI, Noble-Lugo A, Rojas-Mendoza F, Suazo-Barahona J, Stoopen-Rometti M, Torres-Flores E, Vallejo-Soto M, Vergara-Fernández O. The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2019; 84:220-240. [PMID: 31014749 DOI: 10.1016/j.rgmx.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.
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Affiliation(s)
| | - N Salgado-Nesme
- División de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - R Carmona-Sánchez
- Unidad de Médica Ambulatoria Christus Muguerza, San Luis Potosí, S.L.P., México.
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México
| | - J Aguilera-Carrera
- Hospital de Especialidades Médicas de la Salud, San Luis Potosí, S.L.P., México
| | | | - C Arnaud-Carreño
- Departamento de Cirugía, Hospital General «Dr. Aurelio Valdivieso», Secretaría de Salud del Estado de Oaxaca, Oaxaca, Oaxaca, México
| | | | - E Coss-Adame
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | | | | | - F Esquivel-Ayanegui
- Hospital General «Dr. Miguel Silva», Secretaría de Salud de Michoacán, Morelia, Michoacán, México
| | - F Roesch-Dietlen
- Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México
| | - A López-Colombo
- Direccción de Educación e Investigación, UMAE Hospital de Especialidades CMN Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - J I Muñoz-Torres
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, BC, México
| | | | | | - J Suazo-Barahona
- Centro de Enfermedades Digestivas, Hospital del Valle, San Pedro Sula, Honduras
| | - M Stoopen-Rometti
- Departamento de Radiología e Imagen, CT Scanner Lomas Altas, Ciudad de México, México
| | - E Torres-Flores
- Hospital General de Zona # 1, Instituto Mexicano del Seguro Social, Pachuca, Hidalgo, México
| | | | - O Vergara-Fernández
- División de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
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18
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Nagata N, Ishii N, Kaise M, Shimbo T, Sakurai T, Akiyama J, Uemura N. Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping. Gastrointest Endosc 2018; 88:841-853.e4. [PMID: 30036505 DOI: 10.1016/j.gie.2018.07.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Very few prospective studies with over 100 samples have evaluated the long-term outcomes of endoscopic therapy for colonic diverticular bleeding (CDB). This study sought to elucidate the recurrent bleeding risk of endoscopic band ligation versus clipping for definitive CDB based on stigmata of recent hemorrhage (SRH). METHODS Patients emergently hospitalized for acute lower GI bleeding and examined by high-resolution colonoscopy were enrolled. Better visualization of SRH from a diverticulum was obtained using a water-jet device. Endoscopic band ligation or clipping was performed as first-line treatment, and patients were prospectively followed after discharge. RESULTS No statistical difference was found between the ligation (n = 61) and clipping (n = 47) groups in baseline characteristics or follow-up period. The probability of 1-year recurrent bleeding was 11.5% in the ligation group versus 37.0% in the clipping group (P = .018). No patients required surgery or experienced perforation. One patient in the ligation group experienced diverticulitis the next day. In patients with recurrent bleeding within 7 days, the recurrent bleeding site was the same diverticulum, and ulceration was found in the ligation group on repeat colonoscopy. In patients with recurrent bleeding after 2 months, repeat colonoscopy identified that the recurrent bleeding site was different, and scar formation was seen in the ligation group. The left side of the colon was an independent predictor for recurrent bleeding in the ligation group but not in the clipping group. CONCLUSIONS Band ligation for definitive CDB has better outcomes than clipping during long-term follow-up after endoscopic therapy, probably because of complete elimination of the diverticulum. CDB can recur at the same diverticulum in the short term but at a different diverticulum in the long term.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoki Ishii
- Gastroenterology Division, Koga Hospital, Koga, Japan; Gastroenterology Division, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsuru Kaise
- Gastroenterology Division, Nippon Medical School, Tokyo, Japan
| | - Takuro Shimbo
- Department of Internal Medicine, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan; Department of Gastroentegology, The Jikei University School of Medicine, Tokyo, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
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19
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Gweon TG, Kim J. Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jinsu Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Ng JL, Marican M, Mathew R. Topical haemostatic powder as a novel endoscopic therapy for severe colonic diverticular bleeding. ANZ J Surg 2018; 89:E56-E60. [DOI: 10.1111/ans.14895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/28/2018] [Accepted: 09/03/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Jia Lin Ng
- Department of Colorectal Surgery; Singapore General Hospital; Singapore
| | - Musfirah Marican
- Department of Colorectal Surgery; Singapore General Hospital; Singapore
| | - Ronnie Mathew
- Department of Colorectal Surgery; Singapore General Hospital; Singapore
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21
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Gupta S, Greenwald DA. Prevention of Recurrent Lower Gastrointestinal Hemorrhage. Gastrointest Endosc Clin N Am 2018; 28:409-424. [PMID: 29933784 DOI: 10.1016/j.giec.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article summarizes current knowledge regarding the incidence of and risk factors associated with recurrent lower gastrointestinal hemorrhage. The literature regarding medical, endoscopic, and surgical methods to prevent rebleeding from diverticulosis, angioectasia, and chronic hemorrhagic radiation proctopathy is reviewed. In addition, the evidence for endoscopic clipping as primary prophylaxis against postpolypectomy bleeding is explored.
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Affiliation(s)
- Shivani Gupta
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1069, New York, NY 10029-6574, USA.
| | - David A Greenwald
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1069, New York, NY 10029-6574, USA
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22
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Patel B, Guo X, Noblet J, Chambers S, Kassab GS. Animal Models of Diverticulosis: Review and Recommendations. Dig Dis Sci 2018; 63:1409-1418. [PMID: 29679297 DOI: 10.1007/s10620-018-5071-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/12/2018] [Indexed: 02/06/2023]
Abstract
Diverticulosis is a structural alteration of the colon tissue characterized by the development of pouch-like structures called diverticula. It afflicts a significant portion of the population in Western countries, with a higher prevalence among the elderly. Diverticulosis is believed to be the result of a synergetic interaction between inherent tissue weakness, diet, colonic microstructure, motility, and genetic factors. A validated etiology has, however, not yet been established. Non-surgical treatment is currently lacking due to this poor understanding, and surgical colon resection is the only long-term solution following recurrent complications. With rising prevalence, the burden of diverticulosis on patients and hospital resources has increased over the past several years. More efficient and less invasive treatment approaches are, thus, urgently needed. Animal models of diverticulosis are crucial to enable a preclinical assessment and evaluation of such novel approaches. This review discusses the animal models of diverticulosis that have been proposed to date. The current models require either a significant amount of time to develop diverticulosis, present a relatively low success rate, or seriously deteriorate the animals' systemic health. Recommendations are thus provided to address these pitfalls through the selection of a suitable animal and the combination of multiple risk factors for diverticulosis.
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Affiliation(s)
- Bhavesh Patel
- California Medical Innovations Institute, Inc., 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA
| | - Xiaomei Guo
- California Medical Innovations Institute, Inc., 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA
| | - Jillian Noblet
- Cook Medical, Inc., 750 Daniels Way, Bloomington, IN, 47404, USA
| | - Sean Chambers
- Cook Medical, Inc., 750 Daniels Way, Bloomington, IN, 47404, USA
| | - Ghassan S Kassab
- California Medical Innovations Institute, Inc., 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA.
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23
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Ito Y, Sakata Y, Yoshida H, Nonaka S, Fujii S, Tanaka Y, Shirai S, Takeshita E, Akutagawa T, Kawakubo H, Yamamoto K, Tsuruoka N, Shimoda R, Iwakiri R, Fujimoto K. High Cost of Hospitalization for Colonic Diverticular Bleeding Depended on Repeated Bleeding and Blood Transfusion: Analysis with Diagnosis Procedure Combination Data in Japan. Digestion 2018; 96:76-80. [PMID: 28723691 DOI: 10.1159/000478256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. METHODS From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). RESULTS Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. CONCLUSION Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.
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Affiliation(s)
- Yoichiro Ito
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
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24
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Ogawa Y, Asayama N, Nagata S. Acute gastrointestinal bleeding from appendiceal diverticulitis diagnosed preoperatively by combined short-interval computed tomography and colonoscopy: A case report. Dig Endosc 2018; 30:392-394. [PMID: 29334144 DOI: 10.1111/den.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/08/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Yutaro Ogawa
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Naoki Asayama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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25
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Higashi R, Kinugasa H, Nakagawa M. Endoscopic band ligation for colonic diverticular bleeding. Dig Endosc 2018; 30:399. [PMID: 29331058 DOI: 10.1111/den.13015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/09/2018] [Indexed: 02/08/2023]
Abstract
Watch a video of this article
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Affiliation(s)
- Reiji Higashi
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan
| | - Hideaki Kinugasa
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan
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26
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Niikura R, Nagata N, Yamada A, Doyama H, Shiratori Y, Nishida T, Kiyotoki S, Yada T, Fujita T, Sumiyoshi T, Hasatani K, Mikami T, Honda T, Mabe K, Hara K, Yamamoto K, Takeda M, Takata M, Tanaka M, Shinozaki T, Fujishiro M, Koike K. A multicenter, randomized controlled trial comparing the identification rate of stigmata of recent hemorrhage and rebleeding rate between early and elective colonoscopy in outpatient-onset acute lower gastrointestinal bleeding: study protocol for a randomized controlled trial. Trials 2018; 19:214. [PMID: 29615078 PMCID: PMC5883587 DOI: 10.1186/s13063-018-2558-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/24/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The clinical benefit of early colonoscopy within 24 h of arrival in patients with severe acute lower gastrointestinal bleeding (ALGIB) remains controversial. This trial will compare early colonoscopy (performed within 24 h) versus elective colonoscopy (performed between 24 and 96 h) to examine the identification rate of stigmata of recent hemorrhage (SRH) in ALGIB patients. We hypothesize that, compared with elective colonoscopy, early colonoscopy increases the identification of SRH and subsequently improves clinical outcomes. METHODS This trial is an investigator-initiated, multicenter, randomized, open-label, parallel-group trial examining the superiority of early colonoscopy over elective colonoscopy (standard therapy) in ALGIB patients. The primary outcome measure is the identification of SRH. Secondary outcomes include 30-day rebleeding, success of endoscopic treatment, need for additional endoscopic examination, need for interventional radiology, need for surgery, need for transfusion during hospitalization, length of stay, 30-day thrombotic events, 30-day mortality, preparation-related adverse events, and colonoscopy-related adverse events. The sample size will enable detection of a 9% SRH rate in elective colonoscopy patients and a SRH rate of ≥ 26% in early colonoscopy patients with a risk of type I error of 5% and a power of 80%. DISCUSSION This trial will provide high-quality data on the benefits and risks of early colonoscopy in ALGIB patients. TRIAL REGISTRATION UMIN-CTR Identifier, UMIN000021129 . Registered on 21 February 2016; ClinicalTrials.gov Identifier, NCT03098173 . Registered on 24 March 2017.
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Affiliation(s)
- Ryota Niikura
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655 Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655 Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Ishikawa Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yanai-shi, Yamaguchi Japan
| | - Tomoyuki Yada
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Ichikawa-shi, Chiba Japan
| | - Tomoki Fujita
- Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru-shi, Hokkaido Japan
| | - Tetsuya Sumiyoshi
- The Center for Digestive Disease, Tonan Hospital, Sapporo-shi, Hokkaido Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui-shi, Fukui Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki-shi, Aomori Japan
| | - Tetsuro Honda
- Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Katsuhiro Mabe
- Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate-shi, Hokkaido Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya-shi, Aichi Japan
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka-shi, Osaka, Japan
| | - Mariko Takeda
- Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Munenori Takata
- Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Mototsugu Tanaka
- Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655 Japan
- Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655 Japan
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27
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Werner DJ, Manner H, Nguyen-Tat M, Kloeckner R, Kiesslich R, Abusalim N, Rey JW. Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature. United European Gastroenterol J 2017; 6:337-342. [PMID: 29774146 DOI: 10.1177/2050640617746299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
Abstract
Lower gastrointestinal bleeding is common and occurs often in elderly patients. In rare cases it is associated with hemorrhagic shock. A large number of such bleedings, which are often caused by colon diverticula, subside spontaneously. Alternatively they can be treated by endoscopic procedures successfully. Given the aging population of our society, the rising incidence of lower gastrointestinal tract bleeding and new anticoagulant therapies, some of the bleedings tend to be severe. Colonoscopy is the established standard procedure for the diagnosis and treatment of lower gastrointestinal bleeding. However, a small number of patients experience re-bleeding or shock; their bleeding does not resolve spontaneously and cannot be treated successfully by endoscopic procedures. In such patients, interventional radiology is very useful for the detection of bleeding and the achievement of hemostasis. Against this background we performed a literature search using PubMed to identify all relevant studies focused on the endoscopic and radiological management of lower gastrointestinal bleeding and present recent conclusions on the subject.
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Affiliation(s)
- David J Werner
- RNS Joint Practice, Department of Radiology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Hendrik Manner
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Marc Nguyen-Tat
- First Department of Internal Medicine, University Medical Center, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Germany
| | - Ralf Kiesslich
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Nael Abusalim
- RNS Joint Practice, Department of Radiology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Johannes W Rey
- Department of Gastroenterology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
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28
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Chen CH, Yang CC, Yeh YH, Mo LR. Endoscopic management of colonic diverticular bleeding. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Huang CL, Wu CH, Chen TH, Lin WP, Sung CM, Kuo CJ, Chen CW, Lin WR, Ho YP, Lin CJ, Hsu CM, Su MY, Chiu CT. Recurrent bleeding of colonic diverticular hemorrhage after endoscopic treatment: Clinical experience of an endoscopic center. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Chun-Lin Huang
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Wei-Pin Lin
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chia-Jung Kuo
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Wei-Ran Lin
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yu-Pin Ho
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chun-Jung Lin
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chen-Ming Hsu
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology; Chang Gung Memorial Hospital; Taoyuan Taiwan
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30
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Niikura R, Nagata N, Doyama H, Ota R, Ishii N, Mabe K, Nishida T, Hikichi T, Sumiyama K, Nishikawa J, Uraoka T, Kiyotoki S, Fujishiro M, Koike K. Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study. World J Gastrointest Endosc 2016; 8:785-794. [PMID: 28042393 PMCID: PMC5159677 DOI: 10.4253/wjge.v8.i20.785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/20/2016] [Accepted: 11/02/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To clarify the current state of practice for colonic diverticular bleeding (CDB) in Japan.
METHODS We conducted multicenter questionnaire surveys of the practice for CDB including clinical settings (8 questions), diagnoses (8 questions), treatments (7 questions), and outcomes (4 questions) in 37 hospitals across Japan. The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.
RESULTS Endoscopists at all 37 hospitals answered the questions, and the mean number of endoscopists at these hospitals was 12.7. Of all the hospitals, computed tomography was performed before colonoscopy in 67% of the hospitals. The rate of bowel preparation was 46.0%. Early colonoscopy was performed within 24 h in 43.2% of the hospitals. Of the hospitals, 83.8% performed clipping as first-line endoscopic therapy. More than half of the hospitals experienced less than 20% rebleeding events after endoscopic hemostasis. No significant difference was observed in the annual number of patients hospitalized for CDB between high- (≥ 700 beds) and low-volume hospitals. More emergency visits (P = 0.012) and endoscopists (P = 0.015), and less frequent participation of nursing staff in early colonoscopy (P = 0.045) were observed in the high-volume hospitals.
CONCLUSION Some practices unique to Japan were found, such as performing computed tomography before colonoscopy, no bowel preparation, and clipping as first-line therapy. Although, the number of staff differed, the practices for CDB were common irrespective of hospital size.
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TOMIZAWA MINORU, SHINOZAKI FUMINOBU, HASEGAWA RUMIKO, SHIRAI YOSHINORI, MOTOYOSHI YASUFUMI, SUGIYAMA TAKAO, YAMAMOTO SHIGENORI, ISHIGE NAOKI. Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding. Biomed Rep 2016; 4:711-714. [PMID: 27284411 PMCID: PMC4887803 DOI: 10.3892/br.2016.654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Lower gastrointestinal (GI) bleeding can be caused by colorectal polyps or cancer. The aim of the present study was to identify blood test variables and medications that can predict lower GI bleeding, which would allow for appropriate colonoscopy. The medical records of patients who underwent colonoscopy from September 2014 to September 2015 were retrospectively analyzed. The selected patients included 278 men (mean age, 67.0±11.5 years) and 249 women (mean age, 69.6±12.0 years). The diagnosis, medications, and blood test variables were compared between patients with and without bleeding. Logistic regression analysis was performed to determine the factors associated with lower GI bleeding. The presence of colorectal polyp and cancer was associated with lower GI bleeding (P=0.0044) with an odds ratio of 6.71 (P=0.0148). No lower GI bleeding was observed in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. The C-reactive protein (CRP) levels were significantly higher in patients with lower GI bleeding (P=0.0227). The Hb levels were lower in patients with lower GI bleeding, however this finding was not statistically significant (P>0.05). No blood test variable was associated with lower GI bleeding. Elevated CRP was associated with lower GI bleeding, while there was no association between the medications and lower GI bleeding.
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Affiliation(s)
- MINORU TOMIZAWA
- Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - FUMINOBU SHINOZAKI
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - RUMIKO HASEGAWA
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - YOSHINORI SHIRAI
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - YASUFUMI MOTOYOSHI
- Department of Neurology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - TAKAO SUGIYAMA
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - SHIGENORI YAMAMOTO
- Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - NAOKI ISHIGE
- Department of Neurosurgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
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Takahashi S, Inaba T, Tanaka N. Delayed perforation after endoscopic band ligation for treatment of colonic diverticular bleeding. Dig Endosc 2016; 28:484. [PMID: 26861564 DOI: 10.1111/den.12627] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Norimitsu Tanaka
- Department of Gastroenterological Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan
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