Ichita C, Goto T, Nishino T, Nakaya S, Shimizu S. Minimum colonoscopy observation time for colonic diverticular bleeding: A new benchmark based on the 5% plateau time. World J Gastroenterol 2025; 31(40): 112033 [DOI: 10.3748/wjg.v31.i40.112033]
Corresponding Author of This Article
Chikamasa Ichita, MD, MSc, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura 247-8533, Kanagawa, Japan. ichikamasa@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 28, 2025 (publication date) through Oct 30, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ichita C, Goto T, Nishino T, Nakaya S, Shimizu S. Minimum colonoscopy observation time for colonic diverticular bleeding: A new benchmark based on the 5% plateau time. World J Gastroenterol 2025; 31(40): 112033 [DOI: 10.3748/wjg.v31.i40.112033]
Chikamasa Ichita, Takashi Nishino, Soichiro Nakaya, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
Chikamasa Ichita, Tadahiro Goto, Sayuri Shimizu, Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0027, Kanagawa, Japan
Tadahiro Goto, TXP Medical Co., Ltd. 41-1 H1O Kanda 706, Kanda Higashimatsushita-cho, Chiyoda-ku, Tokyo 101-0042, Japan
Author contributions: Ichita C conceived and designed the study, extracted the data with Nishino T and Nakaya S, and performed data analysis and interpretation; Shimizu S contributed to the statistical analyses; Ichita C drafted the manuscript; Goto T and Shimizu S critically revised the intellectual content of the manuscript; All authors reviewed and approved the final version of the manuscript and are responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This study was approved by the Institutional Review Board of the Future Medical Research Centre Ethical Committee (Approval No. TGE1304-024).
Informed consent statement: This was an observational study based on medical records and did not involve the use of human-derived biological samples. Informed consent was obtained from all participants via an opt-out method published on the hospital website. The Ethics Committee approved the consent procedure.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Owing to ethical restrictions, the data are not publicly available. These data are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chikamasa Ichita, MD, MSc, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura 247-8533, Kanagawa, Japan. ichikamasa@yahoo.co.jp
Received: July 16, 2025 Revised: August 8, 2025 Accepted: September 16, 2025 Published online: October 28, 2025 Processing time: 103 Days and 17.4 Hours
Abstract
BACKGROUND
Colonic diverticular bleeding (CDB) is a leading cause of gastrointestinal bleeding-related hospitalizations in Japan and is increasingly recognized as a significant burden in the United States. Identifying the stigmata of a recent hemorrhage (SRH) during colonoscopy enables targeted hemostasis and reduces rebleeding. However, no benchmark exists for an appropriate observation duration, resulting in operator-dependent variation. Short observation periods may lead to missed SRH, whereas unnecessarily prolonged procedures, particularly in older patients, can increase patient burden and limit endoscopy unit availability.
AIM
To establish a practical benchmark for minimum colonoscopy observation time to ensure reliable SRH detection in patients with CDB.
METHODS
We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital. The Observation time was measured from scope insertion to SRH detection (excluding therapeutic time) or withdrawal. The primary outcome, the “5% plateau time”, was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%. Computed tomography (CT)-based stratified analyses were performed by endoscopists who conducted ≥ 10% of procedures.
RESULTS
Of the 1039 patients who underwent colonoscopy, 845 (mean age 77 ± 11 years; 64.5% male) were included. Nine board-certified endoscopists performed the procedures. SRH was detected in 286 patients (33.8%), with a median detection time of 19 minutes (interquartile range, 12-28 minutes). The overall 5% plateau time was 40 minutes and varied according to the CT findings: 40, 35, and 30 minutes for no extravasation, right-sided extravasation, and left-sided extravasation, respectively. This time point corresponded to when 80%-90% of SRH cases were detected. Despite variations in SRH detection rates and observation durations among endoscopists, the 5% plateau time was consistently approximately 40 minutes.
CONCLUSION
Although it varied according to the CT findings, the overall 5% plateau time was 40 minutes. This offers a practical benchmark for the minimum observation time without SRH detection.
Core Tip: This study introduces the “5% plateau time” as a novel benchmark for determining the minimum necessary colonoscopy observation time in colonic diverticular bleeding (CDB). By analyzing 845 cases, we found that stigmata of recent hemorrhage (SRH) detection significantly diminished beyond 40 minutes, with stratified times of 40, 35, and 30 minutes, depending on the computed tomography findings. This time-based metric offers practical guidance for balancing the diagnostic yield and procedural burden, particularly in older adults. By identifying the minimum observation time necessary for adequate SRH detection, the 5% plateau time supports a safer and more consistent endoscopic management of CDB.
