Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study

被引：23

作者：

Gobinet-Suguro, Maya ^{[1
]}

Nagata, Naoyoshi ^{[2
,3
]}

Kobayashi, Katsumasa ^{[4
]}

Yamauchi, Atsushi ^{[5
]}

Yamada, Atsuo ^{[6
]}

Omori, Jun ^{[7
]}

Ikeya, Takashi ^{[8
]}

Aoyama, Taiki ^{[9
]}

Tominaga, Naoyuki ^{[10
]}

Sato, Yoshinori ^{[11
]}

Kishino, Takaaki ^{[12
]}

Ishii, Naoki ^{[13
]}

Sawada, Tsunaki ^{[14
]}

Murata, Masaki ^{[15
]}

Takao, Akinari ^{[16
]}

Mizukami, Kazuhiro ^{[17
]}

Kinjo, Ken ^{[18
]}

Fujimori, Shunji ^{[19
]}

Uotani, Takahiro ^{[20
]}

Fujita, Minoru ^{[21
]}

Sato, Hiroki ^{[22
]}

Suzuki, Sho ^{[23
,24
]}

Narasaka, Toshiaki

Hayasaka, Junnosuke ^{[27
]}

Funabiki, Tomohiro ^{[25
,26
,28
,29
]}

Kinjo, Yuzuru ^{[30
]}

Mizuki, Akira ^{[31
]}

Kiyotoki, Shu ^{[32
]}

Mikami, Tatsuya ^{[33
]}

Gushima, Ryosuke ^{[34
]}

Fujii, Hiroyuki ^{[35
]}

Fuyuno, Yuta ^{[36
]}

Gunji, Naohiko ^{[37
]}

Toya, Yosuke ^{[38
]}

Narimatsu, Kazuyuki ^{[39
]}

Manabe, Noriaki ^{[40
]}

Nagaike, Koji ^{[41
]}

Kinjo, Tetsu ^{[42
]}

Sumida, Yorinobu ^{[43
]}

Funakoshi, Sadahiro ^{[44
]}

Kawagishi, Kana ^{[45
]}

Matsuhashi, Tamotsu ^{[46
]}

Komaki, Yuga ^{[47
,48
]}

Miki, Kuniko ^{[2
]}

Watanabe, Kazuhiro

Uemura, Naomi ^{[2
,49
]}

Itawa, Eri ^{[2
]}

Sugimoto, Mitushige ^{[2
]}

Fukuzawa, Masakatsu ^{[1
]}

Kawai, Takashi ^{[2
]}

机构：

[1] Tokyo Med Univ, Dept Gastroenterol & Hepatol, Tokyo, Japan

[2] Tokyo Med Univ, Dept Gastroenterol Endoscopy, 6-7-1,Nishi Shinjuku Ku, Tokyo 1600023, Japan

[3] Natl Ctr Global Hlth & Med, Dept Gastroenterol & Hepatol, Tokyo, Japan

[4] Tokyo Metropolitan Bokutoh Hosp, Dept Gastroenterol, Tokyo, Japan

[5] Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Gastroenterol & Hepatol, Osaka, Japan

[6] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[7] Nippon Med Sch, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[8] St Lukes Int Univ, Dept Gastroenterol, Tokyo, Japan

[9] Hiroshima City Asa Citizens Hosp, Dept Gastroenterol, Hiroshima, Japan

[10] Saga Med Ctr Koseikan, Dept Gastroenterol, Saga, Japan

[11] St Marianna Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Sch Med, Kawasaki, Kanagawa, Japan

[12] Nara City Hosp, Dept Gastroenterol & Hepatol, Ctr Digest & Liver Dis, Nara, Japan

[13] Tokyo Shinagawa Hosp, Dept Gastroenterol, Tokyo, Japan

[14] Nagoya Univ Hosp, Dept Endoscopy, Nagoya, Aichi, Japan

[15] Natl Hosp Org Kyoto Med Ctr, Dept Gastroenterol, Kyoto, Japan

[16] Ctr Komagome Hosp, Tokyo Metropolitan Canc & Infect Dis, Dept Gastroenterol, Tokyo, Japan

[17] Oita Univ, Dept Gastroenterol, Oita, Japan

[18] Fukuoka Univ, Dept Gastroenterol, Chikushi Hosp, Fukuoka, Japan

[19] Nippon Med Sch, Chiba Hokusoh Hosp, Dept Gastroenterol, Chiba, Japan

[20] Japanese Red Cross Shizuoka Hosp, Dept Gastroenterol, Shizuoka, Japan

[21] Kawasaki Med Sch, Gen Med Ctr, Div Endoscopy & Ultrasonog, Dept Clin Pathol & Lab Med, Okayama, Japan

[22] Niigata Univ, Grad Sch Med & Dent Sci, Div Gastroenterol, Niigata, Japan

[23] Univ Miyazaki Hosp, Ctr Digest Dis, Dept Gastroenterol & Hepatol, Miyazaki, Japan

[24] Univ Miyazaki Hosp, Div Endoscopy, Miyazaki, Japan

[25] Univ Tsukuba Hosp, Dept Gastroenterol, Ibaraki, Japan

[26] Univ Tsukuba Hosp, Endoscop Ctr, Ibaraki, Japan

[27] Toranomon Gen Hosp, Dept Gastroenterol, Tokyo, Japan

[28] Saiseikai Yokohamashi Tobu Hosp, Emergency & Crit Care Ctr, Yokohama, Kanagawa, Japan

[29] Fujita Hlth Univ Hosp, Dept Emergency Med, Toyoake, Aichi, Japan

[30] Naha City Hosp, Dept Gastroenterol, Okinawa, Japan

[31] Tokyo Saiseikai Cent Hosp, Dept Internal Med, Tokyo, Japan

[32] Shuto Gen Hosp, Dept Gastroenterol, Yamaguchi, Japan

[33] Hirosaki Univ Hosp, Div Endoscopy, Aomori, Japan

[34] Kumamoto Univ, Grad Sch Med Sci, Dept Gastroenterol & Hepatol, Kumamoto, Japan

[35] Natl Hosp Org Fukuokahigashi Med Ctr, Dept Gastroenterol & Hepatol, Fukuoka, Japan

[36] Kyushu Univ, Grad Sch Med Sci, Dept Med & Clin Sci, Fukuoka, Japan

[37] Fukushima Med Univ, Dept Gastroenterol, Fukushima, Japan

[38] Iwate Med Univ, Div Gastroenterol, Dept Internal Med, Morioka, Iwate, Japan

[39] Natl Def Med Coll, Dept Internal Med, Saitama, Japan

[40] Kawasaki Med Sch, Div Endoscopy & Ultrasonog, Dept Clin Pathol & Lab Med, Okayama, Japan

[41] Suita Municipal Hosp, Dept Gastroenterol & Hepatol, Osaka, Japan

[42] Univ Ryukyus Hosp, Dept Endoscopy, Okinawa, Japan

[43] Natl Hosp Org Kyushu Med Ctr, Dept Gastroenterol, Fukuoka, Japan

[44] Fukuoka Univ Hosp, Dept Gastroenterol Endoscopy, Fukuoka, Japan

[45] Kitasato Univ, Sch Med, Dept Gastroenterol, Kitasato, Kanagawa, Japan

[46] Akita Univ, Dept Gastroenterol & Neurol, Grad Sch Med, Akita, Japan

[47] Kagoshima Univ, Grad Sch Med & Dent Sci, Digest & Lifestyle Dis, Kagoshima, Japan

[48] Kagoshima Univ, Grad Sch Med & Dent Sci, Hyg & Hlth Promot Med, Kagoshima, Japan

[49] Kohnodai Hosp, Dept Gastroenterol & Hepatol, Natl Ctr Global Hlth & Med, Chiba, Japan

来源：

GASTROINTESTINAL ENDOSCOPY | 2022年 / 95卷 / 06期

关键词：

ENDOSCOPIC BAND LIGATION; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; LONG-TERM OUTCOMES; RISK-FACTORS; COMPUTED-TOMOGRAPHY; NATURAL-HISTORY; COLONOSCOPY; DIAGNOSIS; HOSPITALIZATION; PREDICTORS;

D O I：

10.1016/j.gie.2021.12.023

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and Aims: Treatment strategies for colonic diverticular bleeding (CDB) based on stigmata of recent hemorrhage (SRH) remain unstandardized, and no large studies have evaluated their effectiveness. We sought to identify the best strategy among combinations of SRH identification and endoscopic treatment strategies. Methods: We retrospectively analyzed 5823 CDB patients who underwent colonoscopy at 49 hospitals throughout Japan (CODE-BLUE J-Study). Three strategies were compared: find SRH (definitive CDB) and treat endoscopically, find SRH (definitive CDB) and treat conservatively, and without finding SRH (presumptive CDB) treat conservatively. In conducting pairwise comparisons of outcomes in these groups, we used propensity score-matching analysis to balance baseline characteristics between the groups being compared. Results: Both early and late recurrent bleeding rates were significantly lower in patients with definitive CDB treated endoscopically than in those with presumptive CDB treated conservatively (<30 days, 19.6% vs 26.0% [P <.001]; <365 days, 33.7% vs 41.6% [P <.001], respectively). In patients with definitive CDB, the early recurrent bleeding rate was significantly lower in those treated endoscopically than in those treated conservatively (17.4% vs 26.7% [P = .038] for a single test of hypothesis; however, correction for multiple testing of data removed this significance). The late recurrent bleeding rate was also lower, but not significantly, in those treated endoscopically (32.0% vs 36.1%, P = .426). Definitive CDB treated endoscopically showed significantly lower early and late recurrent bleeding rates than when treated conservatively in cases of SRH with active bleeding, non-active bleeding, and in the right-sided colon but not left-sided colon. Conclusions: Treating definitive CDB endoscopically was most effective in reducing recurrent bleeding over the short and long term, compared with not treating definitive CDB or presumptive CDB. Physicians should endeavor to find and treat SRH for suspected CDB.

引用

页码：1210 / +

页数：25

共 58 条

[1] Endoscopic detachable snare ligation: a new treatment method for colonic diverticular hemorrhage
Akutsu, Daisuke
Narasaka, Toshiaki
Wakayama, Mariko
Terasaki, Masahiko
Kaneko, Tsuyoshi
Matsui, Hirofumi
Suzuki, Hideo
Hyodo, Ichinosuke
Mizokami, Yuji
[J]. ENDOSCOPY, 2015, 47 (11) : 1039 - 1042
[2] Risk of recurrence and long-term outcomes after colonic diverticular bleeding
Aytac, Erman
Stocchi, Luca
Gorgun, Emre
Ozuner, Gokhan
[J]. INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 2014, 29 (03) : 373 - 378
[3] Endoscopic therapy of acute diverticular hemorrhage
Bloomfeld, RS
Rockey, DC
Shetzline, MA
[J]. AMERICAN JOURNAL OF GASTROENTEROLOGY, 2001, 96 (08) : 2367 - 2372
[4] A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION
CHARLSON, ME
POMPEI, P
ALES, KL
MACKENZIE, CR
[J]. JOURNAL OF CHRONIC DISEASES, 1987, 40 (05): : 373 - 383
[5] Couto-Worner Ignacio, 2013, Rev. esp. enferm. dig., V105, P495, DOI 10.4321/s1130-01082013000800010
[6] Doi H, CAN J GASTROENTEROL
[7] Risk factors for early re-bleeding and associated hospitalization in patients with colonic diverticular bleeding
Fujino, Y.
Inoue, Y.
Onodera, M.
Kikuchi, S.
Endo, S.
Shozushima, T.
Suzuki, K.
[J]. COLORECTAL DISEASE, 2013, 15 (08) : 982 - 986
[8] Elective endoscopic clipping for the treatment of symptomatic diverticular disease: a potential for 'cure'
Haji, Amyn
Plastiras, Aris
Ortenzi, Monica
Gulati, Shraddha
Emmanuel, Andrew
Hayee, Bu'Hussain
[J]. GUT, 2019, 68 (04) : 582 - 584
[9] Harfouche M, 2021, MEDRXIV, DOI [10.1101/2021.01, DOI 10.1101/2021.01]
[10] Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding
Honda, Hirokazu
Ishii, Naoki
Takasu, Ayaka
Shiratori, Yasutoshi
Omata, Fumio
[J]. JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2019, 34 (10) : 1784 - 1792

← 1 2 3 4 5 6 →