Introduction
Although the recommended method of an initial examination of hematochezia is colonoscopy, computed-enhanced CT (CECT) is an appealing diagnostic modality for the same disorder, because it has a superior ability of detecting active bleeding and it is widely available, fast, and minimally invasive. In many centers, CECT has already become an established method for characterizing the location of hematochezia. However, its impact on clinical courses of patients with colon diverticular bleeding is fully known. We conducted this study to assess them on the basis of single-center experience in Japan.
Aims & Methods
Consecutive 370 patients with colon diverticular bleeding from April 2002 to January 2023 were enrolled. Diagnosis of colon diverticular bleeding was based on total colonoscopy. Patients were divided into two groups who underwent initial examinations via CECT and colonoscopy.
Patient attributes, clinical data, and outcomes (length of hospital stay, re-bleeding rate, blood transfusion units and 30 days survival rate) were retrospectively analyzed. The patient characteristics and outcomes were compared between two groups using χ2 test or Fisher’s exact test.
Results
279 patients were men (75.4%). The average age was 70.0(30-94) years old. Initial CECT was performed to 204 patients (Group A) (54.9%) and remaining 166(group B).
Patients in group A were more likely to have cerebrovascular disorder.
Findings for other characteristics were similar between two groups.
In Group A, CECT revealed extravasation in 110 patients (53.9%).
Emergent colonoscopy was performed in 118 patients (extravasation positive 100: negative 18) and found bleeding point in 46 patients (extravasation positive 43: negative 3).
In Group B, emergent colonoscopy was performed in 70 patients and found bleeding point in 19(27.1%) patients.
Patients in group A required more blood transfusion units than group B significantly (3.36 ± 6.28 units in group A vs. 1.53 ± 2.96 units in Group B, p=0.001).
No significant difference was observed in terms of length of hospital stay (10.64 ± 7.11 days in group A vs.9.95 ± 5.37 days in Group B ,p=0.32) , recurrent bleeding rate (23.6 % in group A vs. 23.4 % in Group B, OR 1.016 ,p=1) , and 30 days survival rate (99.5% in Group A vs. 100 % in Group B, OR 1.005 ,p=1)
Conclusion
Emergent colonoscopy, subsequent to initial CECT which revealed extravasation, can detect bleeding point more efficiently in patients with colon diverticular bleeding. But, CECT did not improve clinical outcomes of these patients in this study.