Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study

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

¹Missing data included. The values in parentheses are percentages, and continuous data are shown as mean ± standard deviation. CDB: Colonic diverticular bleeding.

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

¹Duplicated data allowed;

²Missing data included. Parenthesis shows percentage. CT: Computed tomography; CDB: Colonic diverticular bleeding; SRH: Stigmata of recent hemorrhage.

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

¹Duplicated data allowed;

²Missing data included. Values in parentheses are percentages. IVR: Interventional radiology; NSAIDs: Non-steroidal anti-inflammatory drugs; SRH: Stigmata of recent bleeding.

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

¹Missing data included. Values in parentheses are percentages. SRH: Stigmata of recent hemorrhage; IVR: Interventional radiology.

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

¹Duplicated data allowed;

²Missing data included. Values in parentheses are percentages. SRH: Stigmata of recent bleeding.