Department of Digestive Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan.
Can J Gastroenterol Hepatol. 2020 Jan 14;2020:3283940. doi: 10.1155/2020/3283940. eCollection 2020.
This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage.
This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy.
Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,=0.690) and recurrent bleeding (22.7% vs. 20.0%, =0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68-12.0, < 0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23-7.53, =0.016).
In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage.
本研究旨在阐明在结肠憩室出血患者中不进行早期结肠镜检查的保守治疗效果和早期结肠镜检查的适应证。
本回顾性研究纳入了 142 名因血便紧急住院并于 2012 年 4 月至 2016 年 12 月期间被诊断为结肠憩室出血的患者。就诊时，仅当生命体征出现休克和腹部增强 CT 显示肠外渗时，才在住院后 24 小时内进行早期结肠镜检查。然而，在其他情况下，患者则接受保守治疗而不进行早期结肠镜检查。对于休克初始治疗失败的患者，则在不进行早期结肠镜检查的情况下进行介入放射学（IVR）治疗。
137 例（96.5%）患者接受了保守治疗，所有患者均实现了自发性止血。相比之下，有 5 例（3.5%）患者需要紧急止血；通过早期结肠镜检查和 IVR 分别有 3 例和 2 例成功止血。两组在早期再出血（7.3% vs. 0%，=0.690）和复发性出血（22.7% vs. 20.0%，=0.685）方面无显著差异。与累积复发性出血率相关的因素包括既往结肠憩室出血史（风险比 5.63，95%置信区间 2.68-12.0， < 0.0001）和口服噻吩吡啶衍生物（风险比 3.05，95%置信区间 1.23-7.53，=0.016）。
在本系列中，不进行早期结肠镜检查的保守治疗对结肠憩室出血患者是成功的。
