Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 785-794
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.785
Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study
Ryota Niikura, Naoyoshi Nagata, Hisashi Doyama, Ryosuke Ota, Naoki Ishii, Katsuhiro Mabe, Tsutomu Nishida, Takuto Hikichi, Kazuki Sumiyama, Jun Nishikawa, Toshio Uraoka, Shu Kiyotoki, Mitsuhiro Fujishiro, Kazuhiko Koike
Ryota Niikura, Mitsuhiro Fujishiro, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
Naoyoshi Nagata, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo 162-8655, Japan
Hisashi Doyama, Ryosuke Ota, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Ishikawa 920-8201, Japan
Naoki Ishii, Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku, Tokyo 104-8560, Japan
Katsuhiro Mabe, Division of Endoscopy, Hokkaido University Hospital, Kita-ku, Sapporo 060-0808, Hokkaido, Japan
Katsuhiro Mabe, Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Kawaharachou, Hakodate-shi 041-0844, Hokkaido, Japan
Tsutomu Nishida, Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka 560-0055, Japan
Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-shi, Fukushima 960-1295, Japan
Kazuki Sumiyama, Department of Endoscopy, the Jikei University School of Medicine, Minato-ku, Tokyo 105-8471, Japan
Jun Nishikawa, Department of Clinical Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube-shi, Yamaguchi 755-0046, Japan
Toshio Uraoka, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo 150-0021, Japan
Shu Kiyotoki, Department of Gastroenterology, Shuto General Hospital, Yanai-shi, Yamaguchi 742-0032, Japan
Mitsuhiro Fujishiro, Endoscopy and Endoscopic Surgery, the University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
Author contributions: Nagata N and Doyama H conceived and designed the experiments; Niikura R and Ota R analyzed the data; Niikura R and Nagata N wrote the paper; Nagata N, Doyama H, Ishii N, Mabe K, Nishida T, Hikichi T, Sumiyama K, Nishikawa J, Uraoka T, Kiyotoki S, Fujishiro M and Koike K contributed to editing the manuscript.
Institutional review board statement: Owing to the anonymous nature of the data in this retrospective questionnaire survey of endoscopists, institutional review board approval was waived.
Informed consent statement: Informed consent was waived because this study included no personal information about patients.
Conflict-of-interest statement: Dr. Mitsuhiro Fujishiro has received grant support from Hoya and Pentax.
Data sharing statement: No additional data are available.
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: Ryota Niikura, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. rniikura@triton.ocn.ne.jp
Telephone: +81-3-38155411 Fax: +81-3-38155411
Received: May 14, 2016
Peer-review started: May 17, 2016
First decision: August 10, 2016
Revised: August 20, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 16, 2016
Processing time: 214 Days and 7.5 Hours
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.

Keywords: Colonic diverticular hemorrhage; Lower gastrointestinal bleeding; Computed tomography; Endoscopy; Bowel preparation

Core tip: Colonic diverticular bleeding (CDB) is increasing in Asia. There are no practice guidelines for CDB, and it is important to determine which recommendation is acceptable to a majority of hospitals. We conducted multicenter questionnaire surveys of 37 hospitals in Japan regarding management of CDB including clinical settings, diagnosis, treatment, and clinical outcomes, and made comparisons between hospitals with different patient volumes and between hospitals in different regions. Thus, practice styles unique to Japan such as performing computed tomography before colonoscopy, no bowel preparation, and clipping as first-line therapy were identified. However, management of CDB was common among hospitals irrespective of hospital size and region.