Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan,
Digestion. 2021;102(5):760-766. doi: 10.1159/000513310. Epub 2021 Feb 8.
Colonic diverticulosis increases with age, leading to a higher risk of colonic diverticular bleeding (CDB) in the elderly. As life expectancy continues to increase, the need for endoscopic hemostasis for CDB in the elderly can also be expected to increase. However, there have been no reports to date on the feasibility of endoscopic hemostasis for elderly CDB patients. Several recent studies have addressed the effectiveness of endoscopic band ligation (EBL) for CDB. In this study, we evaluate the safety and effectiveness of EBL in elderly CDB patients compared to younger CDB patients.
We retrospectively analyzed the medical records of consecutive patients treated with EBL for the first time at a tertiary referral center between March 2011 and November 2017. Patients were grouped according to age into those at least 75 years old (the Elderly) and those <75 years old (the Nonelderly). Patient characteristics, technical success, and complications were compared between the two groups.
EBL was performed in 153 patients during the study period (49 Elderly patients and 104 Nonelderly patients). Elderly patients were less likely to be male (p < 0.001) and had lower hemoglobin levels on admission (p < 0.001). Bleeding on the right side of the splenic flexure was observed more frequently in the Nonelderly (p = 0.002). Charlson Comorbidity Index (CCI) and use of antithrombotic agents were significantly higher in the Elderly (p < 0.001 and p < 0.001, respectively). Active bleeding tended to be observed more frequently in the Elderly (p = 0.054), while the difference was not significant. There were no significant differences in the shock index, procedure time, or units of packed red blood cells transfused between the 2 groups. No significant differences in the technical success rate (97.1 vs. 98%, p = 0.76), early rebleeding rate (10.2 vs. 14.4%, p = 0.47), or other complications (2 vs. 1%, p = 0.58) were observed. Perforation and abscess formation were not observed in either group. Female gender, left-sidedness, higher CCI, and lower hemoglobin level were all significantly more frequently observed in the Elderly on multiple logistic regression analysis.
DISCUSSION/CONCLUSION: EBL may be similarly safe and effective for the treatment of CDB in the elderly as in the nonelderly.
随着年龄的增长，结肠憩室病的发病率增加，老年人患结肠憩室出血（CDB）的风险也随之增加。随着预期寿命的不断延长，对老年人 CDB 内镜止血的需求也有望增加。然而，迄今为止，尚无关于老年 CDB 患者内镜止血可行性的报道。最近的几项研究已经探讨了内镜套扎（EBL）治疗 CDB 的有效性。在这项研究中，我们评估了与年轻的 CDB 患者相比，EBL 治疗老年 CDB 患者的安全性和有效性。
我们回顾性分析了 2011 年 3 月至 2017 年 11 月期间在一家三级转诊中心首次接受 EBL 治疗的连续患者的病历。根据年龄将患者分为至少 75 岁（老年组）和<75 岁（非老年组）。比较两组患者的特征、技术成功率和并发症。
在研究期间，EBL 共治疗了 153 例患者（49 例老年患者和 104 例非老年患者）。老年患者中男性比例较低（p<0.001），入院时血红蛋白水平较低（p<0.001）。非老年患者中脾曲右侧出血更为常见（p=0.002）。Charlson 合并症指数（CCI）和抗血栓药物的使用在老年组中显著更高（p<0.001 和 p<0.001）。老年患者中活动性出血的发生率更高（p=0.054），但差异无统计学意义。两组间休克指数、手术时间或输注单位的红细胞悬液无显著差异。两组间技术成功率（97.1% vs. 98%，p=0.76）、早期再出血率（10.2% vs. 14.4%，p=0.47）或其他并发症（2% vs. 1%，p=0.58）均无显著差异。两组均未发生穿孔和脓肿形成。多因素逻辑回归分析显示，老年患者中女性、左侧、CCI 较高和血红蛋白水平较低的发生率均显著较高。
讨论/结论：EBL 治疗老年 CDB 的安全性和有效性可能与非老年患者相似。
