Risk factor analysis for early rebleeding after endoscopic treatment for colonic diverticular bleeding with stigmata of recent hemorrhage

Atsushi Yamauchi; Tadayuki Kou; Takuya Kishimoto; Yuki Mori; Kazuki Osawa; Kei Iimori; Kosuke Iwano; Yuya Kawai; Kenji Sawada; Kensuke Hamada; Satoshi Nishimura; Yoshiharu Mori; Kotaro Watanabe; Shunjiro Azuma; Toshihiro Morita; Akira Kurita; Kiyotaka Kawaguchi; Yoshiki Suginoshita; Toshiro Katayama; Shujiro Yazumi

doi:10.1002/jgh3.12535

Risk factor analysis for early rebleeding after endoscopic treatment for colonic diverticular bleeding with stigmata of recent hemorrhage

JGH Open. 2021 Mar 27;5(5):573-579. doi: 10.1002/jgh3.12535. eCollection 2021 May.

Authors

Atsushi Yamauchi¹, Tadayuki Kou¹, Takuya Kishimoto¹, Yuki Mori¹, Kazuki Osawa¹, Kei Iimori¹, Kosuke Iwano¹, Yuya Kawai¹, Kenji Sawada¹, Kensuke Hamada¹, Satoshi Nishimura¹, Yoshiharu Mori¹, Kotaro Watanabe¹, Shunjiro Azuma¹, Toshihiro Morita¹, Akira Kurita¹, Kiyotaka Kawaguchi¹, Yoshiki Suginoshita¹, Toshiro Katayama², Shujiro Yazumi¹

Affiliations

¹ Department of Gastroenterology and Hepatology Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan.
² Department of Medical Engineering, Faculty of Health Science Morinomiya University of Medical Sciences Osaka Japan.

Abstract

Background and aim: Colonic diverticular bleeding is a common cause of acute lower gastrointestinal bleeding. Endoscopic hemostasis is generally selected as the first-line treatment; however, a considerable number of patients experience early rebleeding after endoscopic treatment. We investigated the risk factors for early rebleeding after endoscopic treatment.

Methods: We retrospectively evaluated the data of 142 consecutive patients who underwent endoscopic treatment (endoscopic clipping or endoscopic band ligation) for colonic diverticular bleeding with stigmata of recent hemorrhage between April 2012 and April 2020. Multivariate logistic regression analysis was conducted to evaluate the statistical relationship between patient characteristics and the incidence of early rebleeding occurring within 30 days after endoscopic treatment.

Results: Of 142 patients, early rebleeding was detected in 34 (23.9%) patients. According to univariate analysis, platelet count of <10 × 10⁴/μL, bleeding from the left-sided colon, and endoscopic clipping usage were associated with early rebleeding (P < 0.05). The subsequent multivariate logistic regression analysis identified bleeding from the left-sided colon (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.73-10.0; P = 0.001) and endoscopic clipping usage (OR, 2.92; 95% CI, 1.21-7.00; P = 0.017) as the independent risk factors for early rebleeding.

Conclusions: Bleeding from the left-sided colon and endoscopic clipping usage were the risk factors for early rebleeding after endoscopic treatment. Using endoscopic band ligation was associated with a decreased risk for early rebleeding compared with the use of endoscopic clipping, indicating that endoscopic band ligation was a preferable endoscopic modality to prevent early recurrent bleeding.

Keywords: endoscopic band ligation; endoscopic clipping; endoscopic modality; left‐sided colon; lower gastrointestinal bleeding.