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©The Author(s) 2016.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 785-794
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.785
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.785
Table 1 Questions and answers regarding clinical settings in 37 hospitals n (%)
No. | Question | Answer (n = 37) | High volume (n = 18) | Low volume (n = 19) | P value | East Japan (n = 21) | West Japan (n = 16) | P value |
1 | Did you answer the questions based on a clinical database? | |||||||
Yes | 31 (83.8) | 16 (51.6) | 15 (48.4) | 18 (58.1) | 13 (41.9) | |||
No | 6 (16.2) | 2 (33.3) | 4 (66.7) | 0.660 | 3 (50.0) | 3 (50.0) | 1.000 | |
2 | Do you have a specific institutional strategy for CDB? | |||||||
Yes | 5 (13.5) | 0 | 5 (100) | 2 (40.0) | 3 (60.0) | |||
No | 32 (86.5) | 18 (56.3) | 14 (43.7) | 0.046 | 19 (59.4) | 13 (40.6) | 0.634 | |
3 | How many patients are hospitalized for CDB annually? | |||||||
1-10 | 12 (32.5) | 7 (58.3) | 5 (41.7) | 7 (58.3) | 5 (41.7) | |||
11-20 | 10 (27.0) | 4 (40.0) | 6 (60.0) | 4 (40.0) | 6 (60.0) | |||
21-30 | 5 (13.5) | 2 (40.0) | 3 (60.0) | 1 (20.0) | 4 (80.0) | |||
≥ 31 | 10 (27.0) | 2 (50.0) | 5 (50.0) | 0.824 | 9 (90) | 1 (10) | 0.035 | |
4 | How many emergency ambulance visits do you receive annually?1 | |||||||
< 2000 | 15 (44.1) | 5 (33.3) | 10 (66.7) | 8 (53.3) | 7 (46.7) | |||
2000-6000 | 11 (32.3) | 4 (36.4) | 7 (63.6) | 5 (45.5) | 6 (54.5) | |||
6000-10000 | 6 (17.7) | 6 (100) | 0 | 3 (50.0) | 3 (50.0) | |||
≥ 10000 | 2 (5.9) | 0 | 2 (100) | 0.012 | 2 (100) | 0 | 0.724 | |
5 | How many endoscopists perform early colonoscopy within 24 h after patient arrival at your hospital? | |||||||
12.7 ± 9.4 | 17.0 ± 11.6 | 8.8 ± 4.4 | 0.015 | 10.4 ± 5.7 | 15.8 ± 12.5 | 0.296 | ||
6 | How many are expert endoscopists with endoscopic hemostasis technical skills are there at your hospital? | |||||||
10.1 ± 7.5 | 13.1 ± 9.5 | 7.3 ± 3.3 | 0.019 | 7.9 ± 3.3 | 13.0 ± 10.2 | 0.143 | ||
7 | Do you have nursing staff who monitor the patients’ vital signs during bowel preparation? | |||||||
Yes | 33 (89.2) | 17 (51.5) | 16 (48.5) | 19 (57.6) | 14 (42.4) | |||
No | 4 (10.8) | 1 (25.0) | 3 (75.0) | 0.604 | 2 (50.0) | 2 (50.0) | 1.000 | |
8 | Do you have nursing staff for early colonoscopy examinations within 24 h after patient arrival at the hospital? | |||||||
Yes | 23 (62.2) | 8 (34.8) | 15 (65.2) | 13 (56.5) | 10 (43.5) | |||
No | 14 (37.8) | 10 (71.4) | 4 (28.6) | 0.045 | 8 (57.1) | 6 (42.9) | 1.000 | |
9 | Do you have a water-jet colonoscope? | |||||||
Yes | 34 (91.9) | 17 (50.0) | 17 (50.0) | 20 (58.9) | 14 (41.1) | |||
No | 3 (8.1) | 1 (33.3) | 2 (66.7) | 1.000 | 1 (33.3) | 2 (66.7) | 0.568 |
Table 2 Questions and answers regarding diagnosis of colonic diverticular bleeding in 37 hospitals n (%)
No. | Question | Answer (n = 37) | High volume (n = 18) | Low volume (n = 19) | P value | East Japan (n = 21) | West Japan (n= 16) | P value |
10 | What do you use as the first-line diagnostic method for hematochezia and suspected CDB? | |||||||
Non-contrast-enhanced CT | 3 (8.1) | 0 | 3 (100) | 0 | 3 (100) | |||
Contrast-enhanced CT | 22 (59.5) | 11 (50.0) | 11 (50.0) | 12 (54.6) | 10 (45.4) | |||
Colonoscopy | 10 (27.0) | 6 (60.0) | 4 (40.0) | 7 (70.0) | 3 (30.0) | |||
Contrast-enhanced CT and colonoscopy | 2 (5.4) | 1 (50.0) | 1 (50.0) | 0.359 | 2 (100) | 0 | 0.101 | |
11 | Can you perform urgent contrast-enhanced CT within 3 h after patient arrival at hospital?2 | |||||||
Yes | 22 (61.1) | 12 (54.6) | 10 (45.4) | 13 (59.1) | 9 (40.9) | |||
No | 14 (38.9) | 6 (42.9) | 8 (57.1) | 0.494 | 7 (50.0) | 7 (50.0) | 0.593 | |
12 | Can you perform early colonoscopy within 24 h after patient arrival at hospital? | |||||||
Yes | 16 (43.2) | 9 (56.3) | 7 (43.7) | 10 (62.5) | 6 (37.5) | |||
No | 21 (56.8) | 9 (42.9) | 12 (57.1) | 0.419 | 11 (52.4) | 10 (47.6) | 0.538 | |
13 | Do you request bowel preparation? | |||||||
Yes | 17 (46.0) | 6 (35.3) | 11 (64.7) | 13 (76.5) | 4 (23.5) | |||
No | 3 (8.1) | 3 (100) | 0 | 2 (66.7) | 1 (33.3) | |||
Case by case | 17 (45.9) | 9 (52.9) | 8 (47.1) | 0.105 | 6 (35.3) | 11 (64.7) | 0.046 | |
14 | Do you use a cap-assisted colonoscopy for early colonoscopy? | |||||||
Yes | 24 (64.9) | 11 (45.8) | 13 (54.2) | 15 (62.5) | 9 (37.5) | |||
No | 13 (35.1) | 7 (53.9) | 6 (46.1) | 0.642 | 6 (46.2) | 7 (53.8) | 0.338 | |
15 | How do you perform colonoscopy to improve identification of SRH?1 | |||||||
Cap-assisted colonoscopy | 17 (46.0) | 10 (58.8) | 7 (41.2) | 0.254 | 10 (58.8) | 7 (41.2) | 0.815 | |
Long cap-assisted colonoscopy | 13 (35.1) | 6 (46.2) | 7 (53.8) | 0.823 | 7 (53.9) | 6 (46.1) | 0.793 | |
Inverting diverticulum via suction of colonoscopy | 18 (48.7) | 11 (61.1) | 7 (38.9) | 0.140 | 11 (61.1) | 7 (38.9) | 0.603 | |
Wash out with water | 36 (97.3) | 18 (50.0) | 18 (50.0) | 1.000 | 21 (58.3) | 15 (41.7) | 0.432 | |
Colonoscopy by multiple doctors | 3 (8.1) | 1 (33.3) | 2 (66.7) | 1.000 | 2 (66.7) | 1 (33.3) | 1.000 | |
Colonoscopy under X-ray | 3 (8.1) | 1 (33.3) | 2 (66.7) | 1.000 | 1 (33.3) | 2 (66.7) | 0.568 | |
16 | Do you examine the small bowel when you are unable to diagnose definite CDB by colonoscopy? | |||||||
Yes | 18 (48.7) | 11 (61.1) | 7 (38.9) | 10 (55.6) | 8 (44.4) | |||
No | 7 (18.9) | 1 (14.3) | 6 (85.7) | 4 (57.1) | 3 (42.9) | |||
Case by case | 12 (32.4) | 6 (50.0) | 6 (50.0) | 0.145 | 7 (58.3) | 5 (41.7) | 1.000 | |
17 | Which modality do you select for the small bowel examination?2 | |||||||
Capsule endoscopy | 29 (85.3) | 17 (58.6) | 12 (41.4) | 18 (62.1) | 11 (37.9) | |||
Balloon-endoscopy | 2 (5.9) | 0 | 2 (100) | 1 (50.0) | 1 (50.0) | |||
Case by case | 3 (8.8) | 1 (33.3) | 2 (66.7) | 0.301 | 1 (33.3) | 2 (66.7) | 0.776 |
Table 3 Questions and answers regarding treatments of colonic diverticular bleeding in 37 hospitals n (%)
No. | Question | Answer (n = 37) | High volume (n = 18) | Low volume (n = 19) | P value | East Japan (n = 21) | West Japan (n = 16) | P value |
18 | What kind of endoscopic treatment do you perform as first-line therapy? | |||||||
Clipping | 31 (83.8) | 15 (48.4) | 16 (51.6) | 1.000 | 17 (54.8) | 14 (45.2) | ||
Endoscopic band ligation | 5 (13.5) | 3 (60.0) | 2 (40.0) | 3 (60.0) | 2 (40.0) | |||
Epinephrine injection | 1 (2.7) | 0 | 1 (100) | 1 (100) | 0 | 1.000 | ||
19 | What kinds of patient undergo non-endoscopic therapy?1 | |||||||
Patients with an unidentified bleeding source | 18 (48.7) | 10 (55.6) | 8 (44.4) | 0.413 | 8 (44.4) | 10 (55.6) | 0.141 | |
Patients with rebleeding | 27 (73.0) | 15 (55.6) | 12 (44.4) | 0.269 | 17 (63.0) | 10 (37.0) | 0.274 | |
Patients with hemorrhagic shock | 25 (67.6) | 15 (60.0) | 10 (40.0) | 0.079 | 13 (52.0) | 12 (48.0) | 0.491 | |
20 | What kind of non-endoscopic therapy do you perform as first-line therapy or when you are unable to identify SRH at endoscopy? | |||||||
IVR | 24 (77.4) | 2 (50.0) | 2 (50.0) | 0.253 | 10 (41.7) | 14 (58.3) | ||
Surgery | 3 (9.7) | 14 (58.3) | 10 (41.7) | 3 (100) | 0 | |||
Barium impaction therapy | 4 (12.9) | 0 | 3 (100) | 3 (75.0) | 1 (25.0) | 0.145 | ||
21 | What kind of treatment do you perform to prevent rebleeding?1 | |||||||
Treatment of diabetes mellitus | 0 | 0 | 0 | NA | 0 | 0 | NA | |
Treatment of hypertension | 6 (17.1) | 2 (33.3) | 4 (66.7) | 0.658 | 3 (50.0) | 3 (50.0) | 1.000 | |
Discontinuation NSAIDs | 14 (40.0) | 7 (50.0) | 7 (50.0) | 0.890 | 10 (71.4) | 4 (28.6) | 0.296 | |
Discontinuation antithrombotic drugs | 22 (62.9) | 11 (50.0) | 11 (50.0) | 0.826 | 15 (68.2) | 7 (31.8) | 0.086 | |
Administrating vitamin D | 0 | 0 | 0 | NA | 0 | 0 | NA | |
Treatment of constipation | 14 (40.0) | 9 (64.3) | 5 (35.7) | 0.129 | 6 (42.9) | 8 (57.1) | 0.163 | |
Administrating a low fiber diet | 5 (14.3) | 2 (40.0) | 3 (60.0) | 1.000 | 3 (60.0) | 2 (40.0) | 1.000 | |
22 | Do you discontinue antithrombotic drugs on admission? | |||||||
Yes | 22 (59.5) | 10 (45.5) | 12 (54.5) | 12 (54.6) | 10 (46.4) | |||
No | 12 (32.4) | 7 (58.3) | 5 (41.7) | 6 (50.0) | 6 (50.0) | |||
Case by case | 3 (8.1) | 1 (33.3) | 2 (66.7) | 0.693 | 3 (100) | 0 | 0.398 | |
23 | Do you have a strategy for restarting antithrombotic drugs?2 | |||||||
Yes | 4 (15.4) | 4 (100) | 0 | 0 | 4 (100) | |||
No | 22 (84.6) | 6 (27.3) | 16 (72.7) | 0.014 | 15 (68.2) | 7 (31.8) | 0.022 |
Table 4 Questions and answers regarding clinical outcomes of colonic diverticular bleeding in 37 hospitals n (%)
No. | Question | Answer (n = 37) | High volume (n = 18) | Low volume (n = 19) | P value | East Japan (n = 21) | West Japan (n = 16) | P value |
24 | How often do you identify SRH in patients who undergo colonoscopy?1 | |||||||
0%-20% | 15 (41.7) | 6 (40.0) | 9 (60.0) | 7 (46.7) | 8 (53.3) | |||
21%-40% | 16 (44.4) | 7 (43.8) | 9 (56.2) | 10 (62.5) | 6 (37.5) | |||
41%-60% | 4 (11.1) | 4 (100) | 0 | 3 (75.0) | 1 (25.0) | |||
61%-80% | 1 (2.8) | 0 | 1 (100) | 0 | 1 (100) | |||
81%-100% | 0 | 0 | 0 | 0.122 | 0 | 0 | 0.658 | |
25 | How often do you experience rebleeding events after endoscopic hemostasis?1 | |||||||
0%-20% | 22 (61.1) | 10 (45.5) | 12 (54.6) | 13 (59.1) | 9 (40.9) | |||
21%-40% | 10 (27.8) | 4 (40.0) | 6 (60.0) | 7 (70.0) | 3 (30.0) | |||
41%-60% | 3 (8.3) | 2 (66.7) | 1 (33.3) | 1 (33.3) | 2 (66.7) | |||
61%-80% | 1 (2.8) | 1 (100) | 0 | 0 | 1 (100) | |||
81%-100% | 0 | 0 | 0 | 0.721 | 0 | 0 | 0.458 | |
26 | How often do you experience rebleeding events after IVR?1 | |||||||
0%-20% | 27 (90.1) | 15 (55.6) | 12 (44.4) | 16 (59.3) | 11 (40.7) | |||
21%-40% | 0 | 0 | 0 | 0 | 0 | |||
41%-60% | 1 (3.3) | 0 | 1 (100) | 0 | 1 (100) | |||
61%-80% | 1 (3.3) | 1 | 1 (100) | 0 | 1 (100) | |||
81%-100% | 1 (3.3) | 1 (100) | 0 | 0.448 | 0 | 1 (100) | 0.090 | |
27 | How often do you experience rebleeding events after barium impaction therapy?1 | |||||||
0%-20% | 10 (71.6) | 6 (60.0) | 4 (40.0) | 9 (90.0) | 1 (10.0) | |||
21%-40% | 1 (7.1) | 0 | 1 (100) | 0 | 1 (100) | |||
41%-60% | 1 (7.1) | 0 | 1 (100) | 0 | 1 (100) | |||
61%-80% | 1 (7.1) | 1 (100) | 0 | 0 | 1 (100) | |||
81%-100% | 1 (7.1) | 0 | 1 (100) | 0.559 | 0 | 1 (100) | 0.005 |
Table 5 Association between procedures and outcomes n (%)
Answer | SRH identification rate2 | ||||||
Procedure1 (Question No. 15) | (n = 37) | 0%-20% (n = 15) | 21%-40% (n = 16) | 41%-60% (n = 4) | 61%-80% (n = 1) | 81%-100% (n = 0) | P for trend |
Cap-assisted colonoscopy | 17 (46.0) | 4 (25.0) | 9 (56.3) | 2 (12.5) | 1 (6.2) | 0 | 0.081 |
Long cap-assisted colonoscopy | 13 (35.1) | 6 (46.2) | 5 (38.5) | 2 (15.3) | 0 | 0 | 0.735 |
Inverting diverticulum via suction of colonoscopy | 18 (48.7) | 5 (29.4) | 10 (58.8) | 2 (11.8) | 0 | 0 | 0.588 |
Wash out with water | 36 (97.3) | 14 (40.0) | 16 (45.7) | 4 (11.4) | 1 (2.9) | 0 | 0.323 |
Colonoscopy by multiple doctors | 3 (8.1) | 2 (66.7) | 1 (33.3) | 0 | 0 | 0 | 0.328 |
Colonoscopy under X-ray | 3 (8.1) | 2 (66.7) | 1 (33.3) | 0 | 0 | 0 | 0.328 |
Answer | Rebleeding rate2 | ||||||
Endoscopic treatment (Question No. 18) | 0%-20% | 21%-40% | 41%-60% | 61%-80% | 81%-100% | P for trend | |
(n = 37) | (n = 22) | (n = 10) | (n = 3) | (n = 1) | (n = 0) | ||
Clipping | 31 (83.8) | 19 (63.3) | 8 (26.7) | 3 (10.0) | 0 | 0 | 0.290 |
Endoscopic band ligation | 5 (13.5) | 2 (40.0) | 2 (40.0) | 0 | 1 (20.0) | 0 | 0.142 |
Epinephrine injection | 1 (2.7) | 1 (100) | 0 | 0 | 0 | 0 | 0.489 |
- Citation: 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(20): 785-794
- URL: https://www.wjgnet.com/1948-5190/full/v8/i20/785.htm
- DOI: https://dx.doi.org/10.4253/wjge.v8.i20.785