Department of Emergency and Internal Medicine, Saitama Citizens Medical Center, 299-1, Shimane, Nishi-ku.
Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical, University, 1-847 Amanuma-cho, Omiya-ku.
Medicine (Baltimore). 2021 Feb 26;100(8):e24736. doi: 10.1097/MD.0000000000024736.
In diverticular bleeding, extravasation detected by computed tomography indicates active bleeding. It is unclear whether an endoscopic procedure is the best method of hemostasis for diverticular bleeding. This retrospective study was conducted to examine the effectiveness of endoscopic hemostasis in preventing diverticular rebleeding with extravasation visualized by contrast-enhanced computed tomography.This single-center, retrospective, the observational study utilized data from an endoscopic database. Adult patients admitted to our hospital due to diverticular bleeding diagnosed by colonoscopy were included. We compared the data between the extravasation-positive and extravasation-negative groups. The primary outcome was the proportion of successful hemostasis without rebleeding within 1 month after the first endoscopic procedure. Altogether, 69 patients were included in the study (n = 17, extravasation-positive group; n = 52, extravasation-negative group). The overall rebleeding rate was 30.4% (21/69). The rebleeding rate was higher in the extravasation-positive group than in the extravasation-negative group, although without a statistically significant difference. However, among the patients who underwent endoscopic hemostasis, the rebleeding rate was significantly higher in the extravasation-positive group than in the extravasation-negative group (50% [8/16] vs 10.5% [2/19], p = .022). In the extravasation-positive group, all 8 patients with rebleeding underwent repeat colonoscopy. Of these, 5 patients required additional clips; bleeding was controlled in 3 patients, while arterial embolization or surgery was required for hemostasis in 2 patients. None of the remaining 3 patients with rebleeding in the extravasation-positive group required clipping; thus, their conditions were only observed.Many patients with diverticular bleeding who exhibited extravasation on computed tomography experienced rebleeding after endoscopic hemostasis. However, bleeding in more than half of these patients could be stopped by 2 endoscopic procedures, without performing transcatheter arterial embolization or surgery even if rebleeding occurred. Some serious major complications due to such invasive interventions are reported in the literature, but colonoscopic complications did not occur in our patients. Endoscopic hemostasis may be the preferred and effective first-line therapy for patients with diverticular bleeding who have extravasation, as visualized by contrast-enhanced computed tomography.
在憩室出血中，计算机断层扫描（CT）检测到的外渗表明存在活动性出血。目前尚不清楚内镜治疗是否是憩室出血止血的最佳方法。本回顾性研究旨在检查对比增强 CT 检测到外渗的情况下，内镜止血预防憩室再出血的效果。这项单中心、回顾性、观察性研究利用了内镜数据库中的数据。纳入因结肠镜检查诊断为憩室出血而入院的成年患者。我们比较了外渗阳性组和外渗阴性组的数据。主要结局是首次内镜治疗后 1 个月内无再出血的止血成功率。共有 69 例患者纳入研究（n=17，外渗阳性组；n=52，外渗阴性组）。总的再出血率为 30.4%（21/69）。外渗阳性组的再出血率高于外渗阴性组，但差异无统计学意义。然而，在外渗阳性组接受内镜止血的患者中，再出血率明显高于外渗阴性组（50%[8/16]比 10.5%[2/19]，p=0.022）。在外渗阳性组中，所有 8 例再出血患者均接受了再次结肠镜检查。其中，5 例患者需要额外夹闭；3 例患者出血得到控制，2 例患者需要动脉栓塞或手术止血。外渗阳性组中其余 3 例再出血患者均未进行夹闭；因此，仅观察其病情。许多在 CT 上显示外渗的憩室出血患者在接受内镜止血后再次出血。然而，在这些患者中，超过一半的出血可以通过 2 次内镜治疗来控制，即使发生再出血，也无需进行经导管动脉栓塞或手术。文献报道了一些因这种有创干预而导致的严重重大并发症，但我们的患者没有发生结肠镜并发症。对于 CT 增强检查显示外渗的憩室出血患者，内镜止血可能是首选且有效的一线治疗方法。
