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Muramatsu T, Fukuzawa M, Madarame A, Kagawa Y, Kikuchi M, Taniguchi S, Shimai S, Matsumoto S, Yamanishi F, Suzuki Y, Nemoto D, Shinohara H, Matsumoto T, Koyama Y, Uchida K, Yamaguchi H, Morise T, Sugimoto A, Yamauchi Y, Kono S, Naito S, Nakamura H, Nutahara D, Matsue Y, Kishimoto Y, Yamamoto K, Kawai T, Itoi T. Rebleeding Risk of Acute Hemorrhagic Rectal Ulcer: A Multicenter Retrospective Study. Intern Med 2024; 63:2481-2490. [PMID: 38346742 DOI: 10.2169/internalmedicine.2706-23] [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] [Indexed: 09/18/2024] Open
Abstract
Objective Acute hemorrhagic rectal ulcer (AHRU) is characterized by sudden, painless, and massive bleeding from rectal ulcers. To date, few studies have analyzed the risk factors for AHRU rebleeding. In this study, we clarified the risk factors of rebleeding after initial hemostasis of AHRU through a multicenter study. Methods A total of 149 patients diagnosed with AHRU between January 2015 and May 2020 at 3 medical centers were enrolled. We retrospectively investigated the following factors: age, sex, body mass index (BMI), performance status (PS), Charlson Comorbidity Index (CCI), comorbidities, medications, laboratory examinations, endoscopic findings, view of the entire rectum on endoscopy, hemostasis method, blood transfusion history, shock, instructions for posture change after initial hemostasis, and clinical course. Results Rebleeding was observed in 35 (23%) of 149 patients. A multivariate analysis showed that significant factors for rebleeding were PS 4 [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.97-13.9; p=0.001], a blood transfusion history (OR, 3.66; 95% CI, 1.41-9.51; p=0.008), low an estimated glomerular filtration rate (eGFR) levels (OR, 0.98; 95% CI, 0.97-0.99; p=0.001), poor view of the whole rectum on endoscopy (OR, 0.33; 95% CI, 0.12-0.90; p=0.030), and use of monopolar hemostatic forceps (OR, 4.89; 95% CI, 1.37-17.4; p=0.014). Conclusion Factors associated with rebleeding of AHRU were a poor PS (PS 4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps.
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Affiliation(s)
- Takahiro Muramatsu
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Akira Madarame
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Yasuyuki Kagawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Miho Kikuchi
- Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Sho Taniguchi
- Department of Gastroenterology, Todachuo General Hospital, Japan
| | - Satoshi Shimai
- Department of Gastroenterology, Todachuo General Hospital, Japan
| | - Sho Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Fumito Yamanishi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Yuka Suzuki
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Daiki Nemoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Hirokazu Shinohara
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Taisuke Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Yohei Koyama
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Kumiko Uchida
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Hayato Yamaguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Takashi Morise
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Akihiko Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Yoshiya Yamauchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Sakiko Naito
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
| | - Hironori Nakamura
- Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Daisuke Nutahara
- Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Yuubu Matsue
- Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
| | | | - Kei Yamamoto
- Department of Gastroenterology, Todachuo General Hospital, Japan
| | - Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
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Uehara N, Inoue K, Kuroki Y, Miyao N, Iwahashi K, Suzuki R, Endo T, Asonuma K, Yoshida E, Koshibu N, Tabuchi A, Tohata M, Hanamura S, Gomi K, Yamamoto Y, Nagahama M. Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding. DEN OPEN 2023; 3:e184. [PMID: 36426137 PMCID: PMC9680167 DOI: 10.1002/deo2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022]
Abstract
Objectives Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment. Methods This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis. Results The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing. In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80–14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09–0.88, p = 0.035). Conclusions In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis‐related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.
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Affiliation(s)
- Natsumi Uehara
- Department of Gastroenterology Medical Topia Soka Hospital Saitama Japan
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Kazuaki Inoue
- Department of Gastroenterology International University of Health and Welfare Narita Hospital Chiba Japan
| | - Yuichiro Kuroki
- Department of Gastroenterology St. Marianna University School of Medicine Yokohama City Seibu Hospital Kanagawa Japan
| | - Naoki Miyao
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Kenta Iwahashi
- Department of Internal medicine Honda Hospital Tokyo Japan
| | - Reika Suzuki
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Toshiyuki Endo
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Kunio Asonuma
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Erika Yoshida
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Naoko Koshibu
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Akihiro Tabuchi
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Misako Tohata
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Shotaro Hanamura
- Department of Gastroenterology Kikuna Memorial Hospital Kanagawa Japan
| | - Kuniyo Gomi
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Masatsugu Nagahama
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
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Takahashi Y, Shimodaira Y, Matsuhashi T, Tsuji T, Fukuda S, Sugawara K, Saruta Y, Watanabe K, Iijima K. Nature and Clinical Outcomes of Acute Hemorrhagic Rectal Ulcer. Diagnostics (Basel) 2022; 12:diagnostics12102487. [PMID: 36292176 PMCID: PMC9600341 DOI: 10.3390/diagnostics12102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Acute hemorrhagic rectal ulcer (AHRU) is a relatively rare disease that can lead to massive hematochezia. Although AHRU is a potentially life-threatening disease, its characteristics and clinical course are not fully understood. In this study, the clinical features were compared between AHRU and lower gastrointestinal bleeding (LGIB) from other causes (non-AHRU). Then, risk factors for all-cause in-hospital mortality in patients with AHRU were identified. A total of 387 consecutive adult patients with LGIB who were managed at two tertiary academic hospitals in Akita prefecture in Japan were retrospectively enrolled. Subjects were divided into AHRU and non-AHRU groups according to the source of bleeding. Regression analyses were used to investigate significant associations, and the results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). AHRU was found as the bleeding source in 72 (18.6%) of the patients. In comparison to non-AHRU, having AHRU was significantly associated with in-hospital onset, age > 65 years, and systolic blood pressure < 90 mmHg. The AHRU group had a significantly higher in-hospital mortality rate in comparison to the non-AHRU group (18.0% vs. 8.3, p = 0.02), and hypoalbuminemia (<2.5 g/dL) was significantly associated with in-hospital mortality in the AHRU group (OR, 4.04; 95%CI, 1.11−14.9; p = 0.03). AHRU accounts for a substantial portion (18.6%) of LGIB in our area, where the aging rate is the highest in Japan. Since AHRU is a potentially life-threatening disease that requires urgent identification and management, further studies to identify robust risk factors associated with serious clinical outcomes are required.
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Affiliation(s)
- Yasutaka Takahashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Department of Gastroenterology, Akita City Hospital, Akita 010-0933, Japan
| | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Correspondence:
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Tsuyotoshi Tsuji
- Department of Gastroenterology, Akita City Hospital, Akita 010-0933, Japan
| | - Sho Fukuda
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kae Sugawara
- Department of Gastroenterology, Akita City Hospital, Akita 010-0933, Japan
| | - Youhei Saruta
- Department of Gastroenterology, Akita City Hospital, Akita 010-0933, Japan
| | - Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
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Yeap E, Lim J, Tay YK, Teoh W. Endoscopic and surgical management of acute haemorrhagic rectal ulcers. ANZ J Surg 2022; 92:2350-2352. [PMID: 35050520 PMCID: PMC9544718 DOI: 10.1111/ans.17478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Evie Yeap
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Victoria, Australia
| | - James Lim
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Victoria, Australia
| | - Yeng Kwang Tay
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Victoria, Australia
| | - William Teoh
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Victoria, Australia
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Okamoto T, Takasu A, Yoshimoto T, Yamamoto K, Shiratori Y, Ikeya T, Fukuda K. Digital compression for hemostasis in acute hemorrhagic rectal ulcer: a report of 4 cases and review of the literature. Clin J Gastroenterol 2021; 14:796-804. [PMID: 33550538 DOI: 10.1007/s12328-021-01353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Acute hemorrhagic rectal ulcer is a relatively rare cause of lower gastrointestinal bleeding. It most commonly occurs in bedridden elderly patients with multiple comorbidities. While the diagnosis can be confirmed on colonoscopy, achieving hemostasis may be difficult due to the poor visual field resulting from severe bleeding and stool remaining in the rectum, the stiffness of ulcers which may preclude effective clipping, the poor tolerability of patients for the procedure, and high risk of recurrence. Here, we present 4 cases of acute hemorrhagic rectal ulcer, where hemostasis could not be achieved through traditional methods. In each case, the assistant introduced his finger into the rectal lumen and digitally compressed the bleeding vessel under endoscopic guidance. Once hemostasis was achieved, the responsible vessel could be visualized and traditional hemostatic measures were taken. No recurrence was observed in any of the cases during follow-up. This simple maneuver can be applied safely and effectively even by assistants attempting the maneuver for the first time. The technique was effective with the endoscope in retroflexed position and could be combined with gel immersion endoscopy to first identify the location of hemorrhage. We also review the existing literature on acute hemorrhagic rectal ulcers.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takaaki Yoshimoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kazuki Yamamoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
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Sugawa C, Culver A, Diebel M, McLeod JS, Lucas CE. Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA: A case series. Medicine (Baltimore) 2020; 99:e19836. [PMID: 32358354 PMCID: PMC7440348 DOI: 10.1097/md.0000000000019836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). METHODS A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. RESULTS AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. CONCLUSION AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.
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Kawabata H, Yamaguchi K, Kawakatsu Y, Ueda Y, Okazaki Y, Hitomi M, Miyata M, Motoi S. Experience of Manual Compression Hemostasis Under Endoscopic Observation for Acute Hemorrhagic Rectal Ulcer. Gastroenterology Res 2019; 12:107-110. [PMID: 31019623 PMCID: PMC6469901 DOI: 10.14740/gr1162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/14/2019] [Indexed: 02/01/2023] Open
Abstract
We experienced two cases in which manual compression hemostasis under endoscopic observation was used in patients with acute hemorrhagic rectal ulcer (AHRU). The patients experienced an episode of massive fresh hematochezia, requiring the blood transfusion. Emergent sigmoidoscopy revealed multiple ulcers with a large protuberant visible vessel or with gush-out hemorrhage on the lower rectum. Endoscopic hemostasis by hemoclips and hypertonic saline-epinephrine injection was attempted; however, mechanical mucosal injury induced by hemoclips and needles caused another gush-out hemorrhage. Thus, the site of bleeding was manually compressed by a forefinger under endoscopic observation. After 5 min, compression hemostasis was achieved, and the postoperative course was uneventful. Manual compression hemostasis under endoscopic observation is useful and worth attempting for AHRU.
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Affiliation(s)
- Hideaki Kawabata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | | | - Yukino Kawakatsu
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Yuki Ueda
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Yuji Okazaki
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Misuzu Hitomi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Masatoshi Miyata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Shigehiro Motoi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
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Hookey L, Barkun A, Sultanian R, Bailey R. Successful hemostasis of active lower GI bleeding using a hemostatic powder as monotherapy, combination therapy, or rescue therapy. Gastrointest Endosc 2019; 89:865-871. [PMID: 30612959 DOI: 10.1016/j.gie.2018.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Acute lower GI bleeding is a frequent cause of hospital admission. The objective of this study was to evaluate the safety and performance of a hemostatic powder (TC-325/Hemospray) in the treatment of nonvariceal lower GI bleeding. METHODS Patients were enrolled into this prospective, multicenter, single-arm study at 4 tertiary care centers in Canada. Fifty patients with active lower GI bleeding of multiple different causes (52 bleeding sites) underwent topical endoscopic application of hemostatic powder. The primary endpoint was powder-related adverse events within 30 days of the index procedure. Secondary endpoints were initial hemostasis as well as recurrent bleeding and mortality within 30 days of the index procedure. RESULTS Most patients (96%) had a single bleeding site, and most bleeding (73%) was due to polypectomy. Overall, the powder was applied as monotherapy in 13 bleeding sites (25%), as combination therapy in 22 bleeding sites (42.3%), and as rescue therapy in 17 bleeding sites (32.7%). Hemostasis was achieved in 98% of patients. No patient experienced a powder-related adverse event. Five patients (10%) developed recurrent bleeding within 30 days. One patient (2%) died within 30 days of powder application, but the death was not directly related to hemostatic powder use. CONCLUSIONS The hemostatic powder is a safe and effective option for patients with lower GI bleeding of varying causes, and in particular, postpolypectomy hemorrhage. The hemostatic powder is effective as monotherapy, part of a combination approach, or as a rescue therapeutic option for the treatment of nonvariceal lower GI bleeding. (Clinical trial registration number: NCT02099435.).
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Affiliation(s)
| | - Alan Barkun
- Department of Medicine, Division of Gastroenterology, McGill University, Montreal, Quebec, Canada
| | - Richard Sultanian
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Robert Bailey
- Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Nishimura N, Mizuno M, Shimodate Y, Doi A, Mouri H, Matsueda K. Risk factors for recurrent bleeding from acute hemorrhagic rectal ulcer. Scand J Gastroenterol 2018; 53:831-834. [PMID: 29852796 DOI: 10.1080/00365521.2018.1476912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless massive bleeding from rectal ulcers, usually in patients who have severe underlying disorders. The rate of recurrent bleeding from AHRU is high, but there have been few studies on the risk factors for recurrent bleeding. The aim of this study was to identify risk factors for recurrent bleeding from AHRU. METHODS Among 27,151 patients who underwent colonoscopy from 2006 November to 2017 March in our hospital, 120 patients with AHRU were retrospectively reviewed to identify risk factors for recurrent bleeding. Factors analyzed were: age, sex, Charlson Comorbidity Index (CCI), comorbidities (congestive heart failure, liver cirrhosis, renal failure, respiratory failure, diabetes mellitus and malignancy), medications (antiplatelet drugs, anticoagulants and steroids); endoscopic therapy and endoscopic features of AHRU. RESULTS Recurrent bleeding from AHRU occurred in 30% of patients (36/120). In multi-variate analysis, individual comorbidities, medications, endoscopic features and endoscopic hemostasis were not significant or independent risk factors for recurrent bleeding. However, a high CCI score (4 or more) was a risk factor (odds ratio, 7.0; 95% confidence interval, 1.8-27.1). Endoscopic hemostasis was performed in 61% (73/120) of AHRU patients, and successful hemostasis was achieved in 99% of the treated patients (72/73). CONCLUSIONS High CCI score was a predictor of recurrent bleeding from AHRU, but individual comorbidities, medications, endoscopic features or endoscopic hemostasis were not. Endoscopic hemostasis for bleeding from AHRU was achieved in most patients, but the recurrent bleeding rate was high.
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Affiliation(s)
- Naoyuki Nishimura
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
| | - Motowo Mizuno
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
| | - Yuichi Shimodate
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
| | - Akira Doi
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
| | - Hirokazu Mouri
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
| | - Kazuhiro Matsueda
- a Department of Gastroenterology and Hepatology , Kurashiki Central Hospital , Kurashiki , Japan
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