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Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage.

Ikeya T, Ishii N, Nakano K, Omata F, Shimamura Y, Ego M, Takagi K, Nakamura K, Fukuda K, Fujita Y - Endosc Int Open (2015)

Bottom Line: Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done.Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 - 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 - 18.1; P = 0.03) were shown to be significant risk factors.The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 - 0.84; P = 0.028).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Endoscopic band ligation (EBL) has been used for hemostasis of colonic diverticular hemorrhage. However, early rebleeding (< 30 days after EBL) has been reported in some cases. The aim of this study was to elucidate risk factors for early rebleeding after EBL in treatment of colonic diverticular hemorrhage.

Patients and methods: A total of 101 patients with definite diverticular hemorrhage treated using EBL from June 2009 to October 2014 were included in the retrospective cohort study and divided into rebleeding and non-rebleeding groups, depending on the presence or absence of early rebleeding. Patients' ages, comorbid diseases, stigmata of recent hemorrhage (SRH) [active bleeding (AB), non-bleeding visible vessel (NBVV), or adherent clot (AC)], locations of bleeding diverticula, and eversions of the diverticula after EBL were retrospectively evaluated in each group.

Results: Early rebleeding occurred in 15 cases. The median time (range) of early rebleeding occurrence was 5 days (range, 2 h to 26 days). Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done. Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 - 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 - 18.1; P = 0.03) were shown to be significant risk factors. The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 - 0.84; P = 0.028).

Conclusions: Younger age, AB of SRH, and leftsided lesions were identified as the risk factors for early rebleeding after EBL in the treatment of colonic diverticular hemorrhage.

No MeSH data available.


Related in: MedlinePlus

Endoscopic view of the colonic diverticulum with active bleeding. b Marking with the hemoclips was done near the diverticulum. c The colonoscope was pulled off and reinserted after attachment of the band ligator. The elastic O-band was released and successful hemostasis was obtained.
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FI209-1: Endoscopic view of the colonic diverticulum with active bleeding. b Marking with the hemoclips was done near the diverticulum. c The colonoscope was pulled off and reinserted after attachment of the band ligator. The elastic O-band was released and successful hemostasis was obtained.

Mentions: The method of EBL for colonic diverticular hemorrhage was the same as that reported in the previous literature 14151617. Well-trained endoscopists and a trainee supervised by the experts performed EBL in the current study. After fluid resuscitation, bowel purge was done with polyethylene glycol and colonoscopy was performed. When the diverticulum with SRH was detected, the area was marked with (Fig. 1 a and 1 b). Epinephrine injection was not performed for the diverticula with AB before EBL. The colonoscope was removed, the band-ligator device was attached to the tip, and the colonoscope was reinserted. The diverticulum was sucked into the band-ligator and the O-band was released (Fig. 1 c).


Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage.

Ikeya T, Ishii N, Nakano K, Omata F, Shimamura Y, Ego M, Takagi K, Nakamura K, Fukuda K, Fujita Y - Endosc Int Open (2015)

Endoscopic view of the colonic diverticulum with active bleeding. b Marking with the hemoclips was done near the diverticulum. c The colonoscope was pulled off and reinserted after attachment of the band ligator. The elastic O-band was released and successful hemostasis was obtained.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612237&req=5

FI209-1: Endoscopic view of the colonic diverticulum with active bleeding. b Marking with the hemoclips was done near the diverticulum. c The colonoscope was pulled off and reinserted after attachment of the band ligator. The elastic O-band was released and successful hemostasis was obtained.
Mentions: The method of EBL for colonic diverticular hemorrhage was the same as that reported in the previous literature 14151617. Well-trained endoscopists and a trainee supervised by the experts performed EBL in the current study. After fluid resuscitation, bowel purge was done with polyethylene glycol and colonoscopy was performed. When the diverticulum with SRH was detected, the area was marked with (Fig. 1 a and 1 b). Epinephrine injection was not performed for the diverticula with AB before EBL. The colonoscope was removed, the band-ligator device was attached to the tip, and the colonoscope was reinserted. The diverticulum was sucked into the band-ligator and the O-band was released (Fig. 1 c).

Bottom Line: Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done.Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 - 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 - 18.1; P = 0.03) were shown to be significant risk factors.The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 - 0.84; P = 0.028).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Endoscopic band ligation (EBL) has been used for hemostasis of colonic diverticular hemorrhage. However, early rebleeding (< 30 days after EBL) has been reported in some cases. The aim of this study was to elucidate risk factors for early rebleeding after EBL in treatment of colonic diverticular hemorrhage.

Patients and methods: A total of 101 patients with definite diverticular hemorrhage treated using EBL from June 2009 to October 2014 were included in the retrospective cohort study and divided into rebleeding and non-rebleeding groups, depending on the presence or absence of early rebleeding. Patients' ages, comorbid diseases, stigmata of recent hemorrhage (SRH) [active bleeding (AB), non-bleeding visible vessel (NBVV), or adherent clot (AC)], locations of bleeding diverticula, and eversions of the diverticula after EBL were retrospectively evaluated in each group.

Results: Early rebleeding occurred in 15 cases. The median time (range) of early rebleeding occurrence was 5 days (range, 2 h to 26 days). Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done. Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 - 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 - 18.1; P = 0.03) were shown to be significant risk factors. The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 - 0.84; P = 0.028).

Conclusions: Younger age, AB of SRH, and leftsided lesions were identified as the risk factors for early rebleeding after EBL in the treatment of colonic diverticular hemorrhage.

No MeSH data available.


Related in: MedlinePlus