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Patel P, Siraw BB, Mehadi AY, Zaher EA, Ebrahim MA, Tafesse YT. Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020). Ann Gastroenterol 2024; 37:449-457. [PMID: 38974086 PMCID: PMC11226741 DOI: 10.20524/aog.2024.0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/04/2024] [Indexed: 07/09/2024] Open
Abstract
Background Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. Methods This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. Results A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Conclusions Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.
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Affiliation(s)
- Parth Patel
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Bekure B. Siraw
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Abdulrahim Yusuf Mehadi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County (Abdulrahim Yusuf Mehadi)
| | - Eli Adrian Zaher
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Mohamed Ayman Ebrahim
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim)
| | - Yordanos T. Tafesse
- Biological Sciences Division, University of Chicago (Yordanos T. Tafesse), USA
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Sano T, Ishikawa T, Azumi M, Sato R, Jimbo R, Kobayashi Y, Sato T, Iwanaga A, Yokoyama J, Honma T. Risk factors for difficult endoscopic hemostasis for colonic diverticular bleeding and efficacy and safety of transcatheter arterial embolization. Medicine (Baltimore) 2023; 102:e35092. [PMID: 37713820 PMCID: PMC10508449 DOI: 10.1097/md.0000000000035092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023] Open
Abstract
This study aimed to investigate the risk factors for difficult endoscopic hemostasis in patients with colonic diverticular bleeding and to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for colonic diverticular bleeding. This study included 208 patients with colorectal diverticular hemorrhage. The non-interventional radiotherapy group consisted of patients who underwent successful spontaneous hemostasis (n = 131) or endoscopic hemostasis (n = 56), whereas the interventional radiotherapy group consisted of patients who underwent TAE (n = 21). Patient clinical characteristics were compared to identify independent risk factors for the interventional radiotherapy group. Furthermore, the hemostasis success rate, rebleeding rate, complications, and recurrence-free survival were compared between patients who underwent endoscopic hemostasis and those who underwent TAE. Bleeding from the right colon (odds ratio [OR]: 7.86; 95% confidence interval [CI]: 1.6-38.8; P = .0113) and systolic blood pressure <80 mm Hg (OR: 0.108; 95% CI: 0.0189-0.62; P = .0126) were identified as independent risk factors for the interventional radiology group. The hemostasis success rate (P = 1.00), early rebleeding rate (within 30 days) (P = .736), late rebleeding rate (P = 1.00), and recurrence-free survival rate (P = .717) were not significantly different between the patients who underwent TAE and those who underwent endoscopic hemostasis. Patients in the TAE group experienced more complications than those in the endoscopic hemostasis group (P < .001). Complications included mild intestinal ischemia (19.0%) and perforation requiring surgery (4.8%). Patients who required interventional radiotherapy were more likely to bleed from the right colon and presented with a systolic blood pressure of <80 mm Hg. TAE is an effective treatment for patients with colonic diverticular hemorrhage that is refractory to endoscopic hemostasis. However, complications must be monitored carefully.
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Affiliation(s)
- Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Motoi Azumi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Ryo Sato
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Ryo Jimbo
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Yuji Kobayashi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toshifumi Sato
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Junji Yokoyama
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
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Development of risk scores for early and late recurrence of colonic diverticular hemorrhage. Eur J Gastroenterol Hepatol 2023; 35:248-254. [PMID: 36708294 DOI: 10.1097/meg.0000000000002478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Colonic diverticular hemorrhage (CDH) often recurs. Although several studies have suggested that early rebleeding (ER) and late rebleeding (LR) should be treated independently, and several ER/LR risk factors have been identified, an integrated system for risk evaluation is still lacking. This study aimed to develop risk scores for early and late rebleeding of CDH. METHODS This two-center, retrospective cohort study included 218 patients between 2008 and 2021. ER and LR risk factors were identified using multivariate analysis, and risk scores were developed using the odds ratios of each risk factor. RESULTS The ER and LR rates were 32.6 and 25.7%, respectively. High heart rate on admission, early endoscopy from the visit, no bowel preparation and no endoscopic treatment were identified as risk factors for ER. On the other hand, LR risk factors included a history of hypertension and diabetes, early endoscopy from the visit, and the use of endoscopic clips. The ER risk score [area under the curve (AUC) = 0.71] was highly sensitive (90.3%) at a cutoff point of 6 and highly specific (98.0%) at a cutoff point of 15. The LR risk score (AUC = 0.70) was highly sensitive (91.1%) at a cutoff point of 2.6 and highly specific (88.3%) at a cutoff point of 7.1. CONCLUSIONS The ER and LR risk scores were established for the first time, and they can divide CDH patients based on their risk of rebleeding as well as provide clinicians with practical information about the CDH management.
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Hayasaka J, Kikuchi D, Odagiri H, Nomura K, Ochiai Y, Okamura T, Suzuki Y, Mitsunaga Y, Dan N, Tanaka M, Yamashita S, Matsui A, Hoteya S. Effectiveness of Clipping for Definitive Colonic Diverticular Bleeding in Preventing Early Recurrent Bleeding. Intern Med 2022; 61:451-460. [PMID: 35173136 PMCID: PMC8907776 DOI: 10.2169/internalmedicine.7702-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Clipping is a common technique for managing colonic diverticular bleeding (CDB), despite the lack of published evidence regarding its effectiveness. We aimed to evaluate the effectiveness of clipping for CDB in preventing early recurrent bleeding. Methods This dual-center retrospective study included 93 patients who underwent emergency hospitalization for bloody stool, diagnosed with definitive CDB, and treated with clipping or conservative treatment. The primary outcome was early recurrent bleeding. A logistic regression analysis was performed to assess the association between the occurrence of early recurrent bleeding and clipping with adjustment for propensity scores. Secondary outcomes included death, transfusion, length of hospitalization, need for transcatheter arterial embolization or surgery, and adverse events. Results The patient characteristics were similar between the clipping (n=85) and conservative treatment (n=8) groups. The rate of early recurrent bleeding was significantly lower in the clipping group than in the conservative treatment group [23.5% (20 cases) vs. 75% (6 cases), p=0.005]. In the propensity score-adjusted logistic regression analysis, the odds ratio for early recurrent bleeding in the clipping group was 0.094 (95% confidence interval, 0.008-0.633, p=0.026). Secondary outcomes were not significantly different between the two groups. Stigmata of recent hemorrhage (SRH) at the time of recurrent bleeding was identified in 79.2% of patients (19/24). In the clipping group, recurrent bleeding was observed in 62.5% of cases (10/16) from the same diverticulum. However, early recurrent bleeding tended to be less likely with direct clipping (p=0.072). Conclusion Clipping for definite CDB was more effective in preventing early recurrent bleeding than conservative treatment.
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Affiliation(s)
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Japan
- Department of Gastroenterology, Toranomon Hospital Kajigaya, Japan
| | | | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | | | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Nobuhiro Dan
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Satoshi Yamashita
- Department of Gastroenterology, Toranomon Hospital, Japan
- Department of Gastroenterology, Toranomon Hospital Kajigaya, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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Ueda T, Mori H, Sekiguchi T, Mishima Y, Sano M, Teramura E, Fujimoto R, Kaneko M, Nakae H, Fujisawa M, Matsushima M, Suzuki H. Successful endoscopic hemostasis compared to transarterial embolization in patients with colonic diverticular bleeding. J Clin Biochem Nutr 2022; 70:283-289. [PMID: 35692675 PMCID: PMC9130068 DOI: 10.3164/jcbn.21-123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Takashi Ueda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Hideki Mori
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven
| | - Tatsuya Sekiguchi
- Department of Diagnostic Radiology, Tokai University School of Medicine
| | - Yusuke Mishima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Masaya Sano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Erika Teramura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Ryutaro Fujimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Motoki Kaneko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Hirohiko Nakae
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Mia Fujisawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Masashi Matsushima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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