Ochi M, Kamoshida T, Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S, Yanaka A. Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding. World J Clin Cases 2021; 9(11): 2446-2457 [PMID: 33889610 DOI: 10.12998/wjcc.v9.i11.2446]
Corresponding Author of This Article
Masanori Ochi, MD, Doctor, Department of Gastroenterology, Hitachi General Hospital, 2 Chome-1-1, Ibaraki 317-0077, Japan. maochi-tei@umin.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
Masanori Ochi, Toshiro Kamoshida, Yukako Hamano, Atsushi Ohkawara, Haruka Ohkawara, Nobushige Kakinoki, Yuji Yamaguchi, Shinji Hirai, Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
Akinori Yanaka, Hitachi Medical Education and Research Center, University of Tsukuba, Ibaraki 317-0077, Japan
Author contributions: Ochi M, Kamoshida T, Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S and Yanaka A contributed equally to this work; Ochi M and Kamoshida T collected and analyzed the data; Ochi M drafted the manuscript; Kamoshida T designed and supervised the study; Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S and Yanaka A offered technical or material support; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Hitachi General Hospital (No. 2019-20). This study was registered with the University Hospital Medical Information Network (UMIN ID: 000037591).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at maochi-tei@umin.ac.jp.
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.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masanori Ochi, MD, Doctor, Department of Gastroenterology, Hitachi General Hospital, 2 Chome-1-1, Ibaraki 317-0077, Japan. maochi-tei@umin.ac.jp
Received: December 25, 2020 Peer-review started: December 25, 2020 First decision: January 17, 2021 Revised: January 25, 2021 Accepted: February 25, 2021 Article in press: February 25, 2021 Published online: April 16, 2021 Processing time: 98 Days and 3.3 Hours
ARTICLE HIGHLIGHTS
Research background
There is little evidence regarding lowered rates of rebleeding within 30 d after early colonoscopy for colonic diverticular bleeding (CDB).
Research motivation
We posited that contrast-enhanced computed tomography (CT) before colonoscopy for CDB reduces risk of rebleeding.
Research objectives
We evaluated the outcomes of early colonoscopy (within 24 h of hospital admission) by timing of contrast-enhanced CT for CDB.
Research methods
This study included patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018. Patients were divided into groups based on the timing of the CT imaging (urgent CT vs elective CT). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH).
Research results
In total, 182 patients [urgent CT (n = 100) vs elective CT (n = 82)] with CDB underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0.01). The rates of rebleeding within 30 d were significantly lower in patients with extravasation-positive images among the urgent CT group (P < 0.05). Secondary analysis to determine the optimal timing for colonoscopy (within 12 h or more than 12 h), showed no difference in the ability to identify SRH or reduce rebleeding rates.
Research conclusions
To improve SRH and rebleeding within 30 d, colonoscopy should be performed within 24 h if contrast-enhanced CT images taken within 4 h of the last hematochezia are extravasation-positive. In other cases, colonoscopy may be electively performed.
Research perspectives
A prospective analysis is needed to add to the evidence for a lowered risk of rebleeding among urgent CT cases with extravasation-positive images.
