Patient Outcomes of Definitive Diverticular Hemorrhage After Colonoscopic, Medical, Surgical, or Embolization Treatment

• Published in: Digestive diseases and sciences Vol. 69; no. 2; pp. 538 - 551
• Main Authors: Wangrattanapranee, Peerapol, Jensen, Dennis M., Khrucharoen, Usah, Jensen, Mary Ellen
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2024; Springer Nature B.V
• Subjects: Biochemistry; Clinical outcomes; Colonoscopy - adverse effects; Diverticulum, Colon - complications; Diverticulum, Colon - diagnostic imaging; Diverticulum, Colon - therapy; Embolization; Gastroenterology; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemorrhage; Hemostasis, Endoscopic - adverse effects; Hepatology; Humans; Medicine; Medicine & Public Health; Oncology; Original Article; Retrospective Studies; Surgery; Transplant Surgery; Outcome comparisons; Colonoscopic hemostasis; Definitive diverticular hemorrhage; Medical treatment
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-023-08199-3

Background
There are few reports of clinical outcomes or the natural history of definitive diverticular hemorrhage (DDH).
Aims
To describe 1-year clinical outcomes of patients with documented DDH treated with colonoscopic hemostasis, angioembolization, surgery, or medical treatment.
Methods
DDH was diagnosed when active bleeding or other stigmata of hemorrhage were found in a colonic diverticulum during urgent colonoscopy or extravasation on angiography or red blood cell (RBC) scanning. This was a retrospective analysis of prospectively collected data of DDH patients from two referral centers between 1993 and 2022. Outcomes were compared for the four treatment groups. The Kaplan–Meier analysis was for time-to-first diverticular rebleed.
Results
162 patients with DDH were stratified based on their final treatment before discharge—104 colonoscopic hemostasis, 24 medical treatment alone, 19 colon surgery, and 15 angioembolization. There were no differences in baseline characteristics, except for a higher Glasgow–Blatchford score in the angioembolization group vs. the colonoscopic group. Post-treatment, the colonoscopic hemostasis group had the lowest rate of RBC transfusions and fewer hospital and ICU days compared to surgical and embolization groups. The medical group had significantly higher rates of rebleeding and reintervention. The surgical group had the highest postoperative complications.
Conclusions
Medically treated DDH patients had significantly higher 1-year rebleed and reintervention rates than the three other treatments. Those with colonoscopic hemostasis had significantly better clinical outcomes during the index hospitalization. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.
Graphical Abstract
Colonoscopic hemostasis is recommended in patients with definitive diverticular hemorrhage for better clinical outcomes. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.