Division of Gastroenterology, Department of Gastroenterology and Hepatology, Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
Colorectal Dis. 2011 Aug;13(8):896-8. doi: 10.1111/j.1463-1318.2010.02350.x. Epub 2010 Jun 10.
Therapeutic barium enema was first reported in 1970. The long-term recurrence rate of colonic diverticular bleeding after therapeutic barium enema was compared with that of endoscopic haemostasis.
This study included 57 consecutive patients admitted between 2003 and 2008 with colonic diverticular bleeding in whom conservative treatment failed to stop bleeding within 3 h of hospital admission. Lower gastrointestinal endoscopy was performed immediately after admission. In 75% of patients, bleeding was from the right colon, and any identifiable source of bleeding was treated by endoscopic haemostasis. Cases with an undetectable source received high-dose barium impaction therapy.
Treatment was as follows: Group A (n = 37) solely by endoscopic haemostasis; Group B (n = 11) solely by therapeutic barium enema group, and Group C (n = 9) by endoscopic haemostasis and therapeutic barium enema. At a follow up of seven (median; range: 1-56) months, recurrent bleeding rates were 18/37 (48.6%), 6/11 (54.5%) and 2/9 (22.2%) (P = 0.3930).
High-dose barium enema is as effective as endoscopic haemostasis for the prevention of recurrent diverticular bleeding.
治疗性钡剂灌肠首次报道于 1970 年。比较治疗性钡剂灌肠后结肠憩室出血的长期复发率与内镜止血的复发率。
本研究纳入了 2003 年至 2008 年间因保守治疗未能在入院后 3 小时内止血而住院的 57 例连续结肠憩室出血患者。入院后立即行下消化道内镜检查。在 75%的患者中，出血来自右半结肠，任何可识别的出血源均通过内镜止血治疗。无法确定出血源的病例接受了大剂量钡剂压迫治疗。
治疗如下：A 组（n=37）仅行内镜止血；B 组（n=11）仅行治疗性钡剂灌肠，C 组（n=9）行内镜止血和治疗性钡剂灌肠。随访 7 个月（中位数；范围：1-56 个月），复发出血率分别为 18/37（48.6%）、6/11（54.5%）和 2/9（22.2%）（P=0.3930）。
大剂量钡剂灌肠与内镜止血预防憩室再出血同样有效。
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