Urgent Contrast-Enhanced Computed Tomography before Early Colonoscopy in the Management of Colonic Diverticular Bleeding: A Multicenter Randomized Controlled Trial.

作者信息

Hirai Yuichiro, Uraoka Toshio, Wada Michiko, Mori Hideki, Fujimoto Ai, Sakakibara Yuko, Toyokawa Tatsuya, Kagaya Takashi, Sasaki Yoshihiro, Mannami Tomohiko, Kuwai Toshio, Watanabe Noriko, Hamada Hiroshige, Esaka Naoki, Kimura Toshihisa, Fujii Hiroyuki, Hosoda Yasuo, Shimada Masaaki, Miyabayashi Hideharu, Somada Shinichi, Mabe Katsuhiro, Inoue Shuji, Saito Hiroki, Furuya Kensuke, Kawamura Norio, Kudo Tomohiro, Hori Keisuke, Sakamoto Naoto, Kato Mototsugu, Higuchi Nobuya, Harada Naohiko

机构信息

Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan,

Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

出版信息

Digestion. 2025;106(3):176-188. doi: 10.1159/000541942. Epub 2024 Oct 15.

INTRODUCTION

Contrast-enhanced computed tomography (CE-CT) has been gaining attention as an initial investigation in the management of colonic diverticular bleeding (CDB), yet the role of CE-CT other than its diagnostic yield has not been adequately clarified. We aimed to determine whether the use of urgent CE-CT improves identification of stigmata of recent hemorrhage (SRH) in subsequently performed early colonoscopy (≤24 h of arrival) or other clinical outcomes of CDB.

METHODS

We conducted a randomized, open-label, controlled trial at 23 institutions in Japan. Outpatients with suspected CDB were randomly assigned to undergo either urgent CE-CT followed by early colonoscopy (urgent-CE-CT + early-colonoscopy group) or early colonoscopy alone (early-colonoscopy group). The primary outcome was SRH identification. Secondary outcomes included successful endoscopic hemostasis, early (<30 days) and late (<1 year) rebleeding, length of hospital stay, and transfusion requirements.

RESULTS

In total, 240 patients, mostly in a hemodynamically stable condition, were randomized. A contrast extravasation on CE-CT was observed in 20 of 115 patients (17.4%) in the urgent-CE-CT + early-colonoscopy group. SRH was identified in 23 of 115 patients (20.0%) in the urgent-CE-CT + early-colonoscopy group and 21 of 118 patients (17.8%) in the early-colonoscopy group (difference, 2.2; 95% confidence interval [CI], -7.9 to 12.3; p = 0.739). Successful endoscopic hemostasis was achieved in 21 patients in each group (18.3% and 17.8%, respectively) (difference, 0.5; 95% CI, -9.4 to 10.4; p = 1.000). There were also no significant differences between groups in early and late rebleeding, length of hospital stay, and transfusion requirements.

CONCLUSION

The use of urgent CE-CT before early colonoscopy did not improve SRH identification or other clinical outcomes in patients with suspected CDB in a hemodynamically stable condition. The routine use of urgent CE-CT as an initial investigation is not recommended in this population, also considering the low rate of extravasation-positive cases (UMIN registry number, UMIN000026865).