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

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Abstract

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.

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Abbreviations

ACCI:

Age-adjusted Charlson Comorbidity Index

ASA:

American Society of Anesthesiologists (Prognostic score)

BMI:

Body mass index

CTA:

Computed tomography angiography

CURE:

Center of Ulcer Research and Education

DDH:

Definitive diverticular hemorrhage

DEP:

Doppler endoscopic probe

GI:

Gastrointestinal

GBS:

Glasgow-Blatchford score

gm/dl:

Grams per deciliter (for hemoglobin level)

ICD:

International Classification of Diseases

ICU:

Intensive care unit

INR:

International normalized ratio

IQR:

Interquartile range

IRB:

Institutional Review Board

MPEC:

Multipolar electrocoagulation

NBVV:

Non-bleeding visible vessel

NSAIDs:

Nonsteroidal anti-inflammatory drugs

RBC:

Red blood cell (transfusion)

SD:

Standard deviation

SRH:

Stigmata of recent hemorrhage

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Acknowledgments

This study was supported by a Veterans Administration Clinical Merit Review Research Grant [grant number 5I01CX001403] and the National Institutes of Health - National Institute of Diabetes and Digestive and Kidney (NIH - NIDDK) Center of Ulcer Research and Education Digestive Diseases Research Core Center (DDRCC) Human Studies Core [grant number P30DK41301].

Author information

Authors and Affiliations

  1. Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

    Peerapol Wangrattanapranee

  2. VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Peerapol Wangrattanapranee, Dennis M. Jensen, Usah Khrucharoen & Mary Ellen Jensen

  3. David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    Dennis M. Jensen, Usah Khrucharoen & Mary Ellen Jensen

  4. Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Dennis M. Jensen, Usah Khrucharoen & Mary Ellen Jensen

  5. VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA

    Dennis M. Jensen, Usah Khrucharoen & Mary Ellen Jensen

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Contributions

PW: Methodology; data curation; writing—original draft. UK: Data curation; formal analysis; writing—review and editing. DMJ: Conceptualization; supervision; funding acquisition; methodology; data curation; writing—review and editing. MEJ: Data curation; writing—review and editing.

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Correspondence to Dennis M. Jensen.

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All human studies have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants in the study gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the study participants were omitted.

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Wangrattanapranee, P., Jensen, D.M., Khrucharoen, U. et al. Patient Outcomes of Definitive Diverticular Hemorrhage After Colonoscopic, Medical, Surgical, or Embolization Treatment. Dig Dis Sci 69, 538–551 (2024). https://doi.org/10.1007/s10620-023-08199-3

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