Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding. Issue 10 (15th May 2019)

• Record Type: Journal Article
• Authors: Honda, Hirokazu; Ishii, Naoki; Takasu, Ayaka; Shiratori, Yasutoshi; Omata, Fumio
• Is Part Of: Journal of gastroenterology and hepatology. Volume 34:Issue 10(2019)
• Page Start: 1784
• Page End: 1792
• Publication Date: 2019-05-15
• Subjects: colon -- diverticular bleeding -- endoscopic hemostasis -- endoscopy; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.14669
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: The risk factors for early rebleeding following the management of colonic diverticular bleeding (CDB) are unclear. This study aimed to determine the risk factors for early rebleeding following initial colonoscopy. Methods: Overall, 370 patients with CDB were divided as having presumptive (229) or definite CDB with stigmata of recent hemorrhage (141) on the basis of initial colonoscopy. Definite CDB cases were treated by either endoscopic clipping (EC) or endoscopic band ligation (EBL) as a first‐line treatment. Time‐to‐event analysis for early rebleeding was performed by Kaplan–Meier methods with log‐rank test between the three groups (presumptive, EC, and EBL). Multivariate Cox proportional hazards regression was used to identify risk factors for early rebleeding. Results: There were 38 and 103 patients in the EC and EBL groups, respectively. Early rebleeding developed in 61 cases (16.5%). The cumulative incidence rates of early rebleeding at 1, 5, and 30 days were 7.7%, 16.4%, and 17.9% in the presumptive group; 1.9%, 7.0%, and 9.5% in the EBL group; and 2.6%, 34.9%, and 37.7% in the EC group, respectively (log‐rank test, P = 0.00059). Moreover, 90.2% of early rebleeding occurred within 5 days. Adjusted hazard ratio (HR) was marginally lower in the presumptive group (HR = 0.50; 95% confidence interval, 0.26–1.01; P = 0.052) and significantly lower in the EBL‐treated group than in the EC group (HR = 0.21; 95% confidence interval, 0.09–0.50; P = 0.0004). Conclusions: Most early rebleeding occurred within 5 days after initial colonoscopy. EC was less effective than EBL in terms of early rebleeding.