Introduction

Although the number of patients with diverticular hemorrhage in the colon has been increasing in recent years, it remains controversial whether emergency colonoscopy is effective for patient outcomes. We developed a new protocol to avoid emergency colonoscopic procedures at night (22:00-05:00), in which colonoscopy were performed within 8, 12, or 24 hours after the patient's arrival, as determined by the presence or absence of extravasation on contrast-enhanced computerized tomography and history of shock at the time of arrival. We have been applying the new protocol for lower gastrointestinal bleeding since the end of 2021. In addition, the endoscopic band ligation method has beenstandardized as the first choice for hemostasis when stigmata of recent hemorrhage (SRH) was identified. The purpose of this study was to verify the effectiveness of the new protocol.

Aims & Methods

Among patients diagnosed as diverticular hemorrhage at Nippon Medical School Hospital, we evaluated clinical outcomes including SRH identification rate, the rebleeding rate after 30 days of hemostasis, the period of hospitalization, and the rate for the hemostasis method after identifying SRH. Each clinical outcome factor afterapplying the protocol (January 2022 to December 2022) was compared with those before the protocol was established (January 2020 to December 2021). The chi-square or Fisher’s exact test was used to compare categorical variables. Mann-Whitney U test was used to compare continuous variables.

Results

Among 93 cases diagnosed as diverticular hemorrhage during the new protocol was in operation, 79 cases followed the protocol and 74 cases underwent endoscopy. Among 191 cases diagnosed as diverticular hemorrhage before new protocol was in operation, 175 cases underwent endoscopy. After the new protocol was in operation, the number of emergency endoscopies at night (22 pm - 5 am) tended to decrease (before, 7.4% vs. after, 4.1%; P=0.41) although the difference was not significant. Both the SRH identification rate (before, 18.3% vs. after, 17.6%; P = 0.90) and the rebleeding rate after 30 days of hemostasis (8.0% vs. 6.8%; P = 0.74) was comparable between two groups. The period of hospitalization was significantly shortened by 1 day after the new protocol was in operation (P = 0.02). The rate for the hemostasis method after identifying SRH using clip/EBL was 8.4%/13% before the new protocol compared with 7.5%/9.7% after the new protocol.

Conclusion

Even when emergency colonoscopic procedures for colonic diverticular hemorrhage were not performed during nighttime whenever possible according to the protocol, similar clinical outcomes were observed by setting up detailed protocols according to the different situations.
There are no different patient outcomes observed even when emergency colonoscopic procedures for colonic diverticular hemorrhage were not performed during nighttime.
Our new protocol has validity to avoid nighttime colonoscopy as much as possible.