Minimum colonoscopy observation time for colonic diverticular bleeding: A new benchmark based on the 5% plateau time

Table 1 Baseline characteristics of patients with colonic diverticular bleeding, n (%)

Variable	All cases (n = 845)	SRH detected (n = 286)	SRH not detected (n = 559)
Age, mean ± SD (years)	77 ± 11	77 ± 11	77 ± 11
Male	545 (64.5)	182 (63.6)	363 (64.9)
BMI, mean ± SD (kg/m2)	22.9 ± 3.8	22.8 ± 3.8	22.9 ± 3.8
Antiplatelet agent use	287 (34.0)	99 (34.6)	188 (33.6)
Anticoagulant agent use	138 (16.3)	47 (16.4)	91 (16.3)
Shock index ≥ 1 on admission	68 (8.0)	25 (8.7)	44 (7.9)
Syncope episode	59 (7.0)	19 (6.6)	40 (7.2)
Colonoscopy within 12 hours	225 (26.6)	94 (32.9)	131 (23.4)
Colonoscopy within 24 hours	520 (61.5)	198 (69.2)	322 (57.6)
History of colectomy	50 (5.9)	12 (4.2)	38 (6.8)
Enema preparation	78 (9.2)	34 (11.9)	44 (7.9)
Laboratory data
White blood cell count, mean ± SD (109/L)	7.5 ± 2.6	7.5 ± 2.6	7.5 ± 2.6
Hemoglobin, mean ± SD (g/dL)	11.2 ± 2.4	11.3 ± 2.5	11.2 ± 2.4
Hematocrit, mean ± SD (%)	34 ± 7.0	34 ± 7.0	34 ± 7.0
CE-CT findings
No extravasation/no CT performed	616 (72.9)	172 (60.1)	444 (79.4)
Right-sided extravasation	129 (15.3)	64 (22.4)	65 (11.6)
Left-sided extravasation	100 (11.8)	50 (17.5)	50 (8.9)
Observation time (minutes), median (IQR)	28 (18-44)	19 (12-28)	33 (22-48)
Successful endoscopic hemostasis	272 (32.0)	272 (95.1)	-

SRH: Stigmata of recent hemorrhage; IQR: Interquartile range; BMI: Body mass index; SRH: Stigmata of recent hemorrhage; CE-CT: Contrast enhanced computed tomography; CT: Computed tomography.

Table 2 Thirty-day rebleeding rates according to stigmata of recent hemorrhage detection and observation time, n (%)

Status	30-day rebleed	P value
SRH detected	61/286 (21.3)	0.007a
SRH not detected	169/559 (30.2)
Observation time ≥ 5% plateau time	74/224 (33.0)	0.26
Observation time < 5% plateau time	95/335 (28.4)

^aP < 0.01 vs stigmata of recent hemorrhage not detected.

SRH: Stigmata of recent hemorrhage.

Table 3 Comparison of patient characteristics and outcomes across endoscopists performing ≥ 10% of procedures, n (%)

Endoscopists	A (n = 113)	B (n = 141)	C (n = 88)	D (n = 161)	P value
SRH detected	49 (43.4)	73 (51.8)	23 (26.1)	37 (23.0)	< 0.001a
Observation time (minutes), median (IQR)	20 (14-33)	27 (18-45)	39 (24-51)	23 (16-36)	< 0.001b
5% plateau time (minutes)	40	40	45	35	-
Age, mean ± SD (years)	79 ± 10	77 ± 11	78 ± 10	76 ± 13	0.42
Male	73 (64.6)	89 (63.1)	45 (51.1)	107 (66.5)	0.10
BMI, mean ± SD (kg/m2)	22.2 ± 3.5	22.7 ± 3.5	23.1 ± 4.2	22.7 ± 3.6	0.28
Antiplatelet agent use	42 (37.2)	53 (37.6)	20 (22.7)	38 (23.6)	0.01c
Anticoagulant agent use	22 (19.5)	17 (12.1)	17 (19.3)	30 (18.6)	0.31
Shock index ≥ 1 on admission	11 (9.7)	7 (5.0)	6 (6.8)	17 (10.6)	0.29
Colonoscopy within 12 hours	33 (29.2)	31 (22.0)	16 (18.2)	41 (25.5)	0.28
History of colectomy	6 (5.3)	6 (4.3)	5 (5.7)	9 (5.6)	0.95
Enema preparation	14 (12.4)	11 (7.8)	5 (5.7)	14 (8.7)	0.38
CE-CT findings					0.04d
No extravasation/no CT performed	76 (67.3)	100 (70.9)	68 (76.1)	123 (76.4)
Right-sided extravasation	26 (23.0)	17 (12.1)	9 (10.2)	25 (15.5)
Left-sided extravasation	11 (9.7)	24 (17.0)	11 (12.5)	13 (8.1)

^aP < 0.001 for comparison of stigmata of recent hemorrhage detection rate among endoscopists.

^bP < 0.001 for comparison of observation time among endoscopists.

^cP < 0.05 for comparison of antiplatelet agent use among endoscopists.

^dP < 0.05 for comparison of contrast-enhanced computed tomography findings among endoscopists.

IQR: Interquartile range; BMI: Body mass index; SRH: Stigmata of recent hemorrhage; CE-CT: Contrast enhanced computed tomography; CT: Computed tomography.