Ikeya Takashi, Ishii Naoki, Nakano Kaoru, Omata Fumio, Shimamura Yuto, Ego Mai, Takagi Koichi, Nakamura Kenji, Fukuda Katsuyuki, Fujita Yoshiyuki
Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
Endosc Int Open. 2015 Oct;3(5):E523-8. doi: 10.1055/s-0034-1392215. Epub 2015 Jun 12.
Endoscopic band ligation (EBL) has been used for hemostasis of colonic diverticular hemorrhage. However, early rebleeding (< 30 days after EBL) has been reported in some cases. The aim of this study was to elucidate risk factors for early rebleeding after EBL in treatment of colonic diverticular hemorrhage.
A total of 101 patients with definite diverticular hemorrhage treated using EBL from June 2009 to October 2014 were included in the retrospective cohort study and divided into rebleeding and non-rebleeding groups, depending on the presence or absence of early rebleeding. Patients' ages, comorbid diseases, stigmata of recent hemorrhage (SRH) [active bleeding (AB), non-bleeding visible vessel (NBVV), or adherent clot (AC)], locations of bleeding diverticula, and eversions of the diverticula after EBL were retrospectively evaluated in each group.
Early rebleeding occurred in 15 cases. The median time (range) of early rebleeding occurrence was 5 days (range, 2 h to 26 days). Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done. Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 - 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 - 18.1; P = 0.03) were shown to be significant risk factors. The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 - 0.84; P = 0.028).
Younger age, AB of SRH, and leftsided lesions were identified as the risk factors for early rebleeding after EBL in the treatment of colonic diverticular hemorrhage.
内镜下套扎术（EBL）已用于结肠憩室出血的止血治疗。然而，部分病例报告了早期再出血（EBL后<30天）情况。本研究旨在阐明EBL治疗结肠憩室出血后早期再出血的危险因素。
2009年6月至2014年10月期间，共有101例确诊为憩室出血且接受EBL治疗的患者纳入本回顾性队列研究，并根据是否发生早期再出血分为再出血组和未再出血组。对每组患者的年龄、合并疾病、近期出血征象（SRH）[活动性出血（AB）、无出血可见血管（NBVV）或附着血凝块（AC）]、出血憩室的位置以及EBL后憩室的翻转情况进行回顾性评估。
15例发生早期再出血。早期再出血发生的中位时间（范围）为5天（范围，2小时至26天）。除1例行手术治疗的病例外，早期再出血可通过保守治疗和/或内镜治疗进行处理。多因素分析显示，年龄<50岁（校正OR，8.7；95%CI 1.6 - 52.5；P = 0.014）和AB（校正OR，4.21；95%CI 1.15 - 18.1；P = 0.03）是显著的危险因素。结肠右侧的风险低于左侧（校正OR，0.21；95%CI 0.04 - 0.84；P = 0.028）。
年龄较小、SRH中的AB以及左侧病变被确定为EBL治疗结肠憩室出血后早期再出血的危险因素。
