Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage?
Objective: We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage. Methods: This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed...
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Online Access: | https://doi.org/10.1177/1179552217728906 |
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doaj-4522666ae38d444c8b826bd9f5d890a62020-11-25T01:44:33ZengSAGE PublishingClinical Medicine Insights: Gastroenterology1179-55222017-09-011010.1177/1179552217728906Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage?Takeshi UeharaSatohiro MatsumotoHiroyuki MiyataniHirosato MashimaObjective: We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage. Methods: This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source. Results: The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy. Conclusions: Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage.https://doi.org/10.1177/1179552217728906 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Takeshi Uehara Satohiro Matsumoto Hiroyuki Miyatani Hirosato Mashima |
spellingShingle |
Takeshi Uehara Satohiro Matsumoto Hiroyuki Miyatani Hirosato Mashima Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? Clinical Medicine Insights: Gastroenterology |
author_facet |
Takeshi Uehara Satohiro Matsumoto Hiroyuki Miyatani Hirosato Mashima |
author_sort |
Takeshi Uehara |
title |
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? |
title_short |
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? |
title_full |
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? |
title_fullStr |
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? |
title_full_unstemmed |
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? |
title_sort |
should emergency endoscopy be performed in all patients with suspected colonic diverticular hemorrhage? |
publisher |
SAGE Publishing |
series |
Clinical Medicine Insights: Gastroenterology |
issn |
1179-5522 |
publishDate |
2017-09-01 |
description |
Objective: We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage. Methods: This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source. Results: The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy. Conclusions: Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage. |
url |
https://doi.org/10.1177/1179552217728906 |
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