Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2446
Peer-review started: December 25, 2020
First decision: January 17, 2021
Revised: January 25, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: April 16, 2021
There is little evidence regarding lowered rates of rebleeding within 30 d after early colonoscopy for colonic diverticular bleeding (CDB).
We posited that contrast-enhanced computed tomography (CT) before colonoscopy for CDB reduces risk of rebleeding.
We evaluated the outcomes of early colonoscopy (within 24 h of hospital admission) by timing of contrast-enhanced CT for CDB.
This study included patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018. Patients were divided into groups based on the timing of the CT imaging (urgent CT vs elective CT). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH).
In total, 182 patients [urgent CT (n = 100) vs elective CT (n = 82)] with CDB underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0.01). The rates of rebleeding within 30 d were significantly lower in patients with extravasation-positive images among the urgent CT group (P < 0.05). Secondary analysis to determine the optimal timing for colonoscopy (within 12 h or more than 12 h), showed no difference in the ability to identify SRH or reduce rebleeding rates.
To improve SRH and rebleeding within 30 d, colonoscopy should be performed within 24 h if contrast-enhanced CT images taken within 4 h of the last hematochezia are extravasation-positive. In other cases, colonoscopy may be electively performed.
A prospective analysis is needed to add to the evidence for a lowered risk of rebleeding among urgent CT cases with extravasation-positive images.